Abstract
One complication of rheumatoid arthritis (RA) is the involvement of the cervical spine (CS). Although prophylactic stabilisation is recommended, the timing at which this should occur is poorly defined. The aim of our study was to evaluate the course of neurological symptoms in terms of the timing of surgery. A total of 34 patients with RA and CS involvement were surgically stabilised. These patients were classified using the Ranawat (RW) score both preoperatively and at an average of 54 months post-operatively. For each patient, the presence of atlantoaxial and subaxial subluxation as well as vertical migration of the odontoid was recorded. The anterior atlantodental interval was also assessed pre- and post-operatively. Improvement was obtained in 20 patients, the clinical situation remained unchanged in three patients and three patients manifested disease progression. In terms of the RW score, the 16 patients with pre-operative RW grades I–II showed no deterioration at the post-operative follow-up, with 13 of these patients showing an improvement; the 12 patients with pre-operative RW grades IIIA–IIIB did not show any improvement of neurological symptoms at follow-up, although seven of these patients subjectively assessed the symptoms to be less severe after surgery; three other patients showed a worsening of symptoms. Our results suggest that preventive stabilisation of CS in RA leads to acceptable results, although the complications of the surgery are obvious. However, early operative treatment may delay the detrimental course of cervical myelopathy in RA.
Résumé
la colonne cervicale (CS) des patients présentant une arthrite rhumatoïde (RA) peut être instable. Le but de cette étude est d’évaluer l’évolution neurologique des signes cliniques en concordance avec la chirurgie. 34 patients présentant une arthrite rhumatoïde ont été stabilisés chirurgicalement. Les patients ont été classés suivant le score de Ranawat (RW) pré et postopératoire. Pour chaque patient, l’existence d’une sub luxation atlaido axoidienne ou d’une migration de l’odontoïde ont été analysées de même que l’espace antérieur C1, C2 en pré et postopératoire. une amélioration est obtenue chez 20 patients, 3 patients ont présenté une situation stationnaire et 3 patients une aggravation malgré la chirurgie. Le score de Ranawat (I et II) ne s’est pas détérioré chez 16 patients, 13 patients ont été améliorés. Pour 12 patients avec un score de Ranawat (IIIA et IIIB) ceux-ci n’ont pas présenté d’amélioration des signes neurologiques, cependant, la symtômatologie subjective était moins importante chez 7 d’entre-eux. Une aggravation des symptômes est apparue chez 7 patients. notre étude nous permet de penser que la stabilisation préventive de la colonne cervicale dans l’arthrite rhumatoïde permet d’avoir des résultats tout à fait acceptables. Cependant, quelques complications peuvent être observées, le traitement précoce permet de retarder la survenue d’une myélopathie cervicale.
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Schmitt-Sody, M., Kirchhoff, C., Buhmann, S. et al. Timing of cervical spine stabilisation and outcome in patients with rheumatoid arthritis. International Orthopaedics (SICO 32, 511–516 (2008). https://doi.org/10.1007/s00264-007-0349-2
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DOI: https://doi.org/10.1007/s00264-007-0349-2