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Cervical spine instability in rheumatoid arthritis
A W Heywood1, I D Learmonth, M Thomas
1Princess Alice Orthopaedic Hospital, University of Cape Town, Plumstead, Republic of South Africa.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1988
Summary
Fusion surgery effectively treated cervical spine instability in rheumatoid arthritis patients. Immobilization alone often resolved neurological compromise, suggesting decompressive procedures may not always be necessary initially.
Area of Science:
- Orthopedics
- Neurosurgery
- Rheumatology
Background:
- Rheumatoid arthritis frequently causes cervical spine instability.
- Instability can lead to significant neurological compromise.
Purpose of the Study:
- To evaluate the efficacy of fusion operations for cervical spine instability in rheumatoid arthritis.
- To determine the necessity of decompressive procedures in conjunction with fusion.
Main Methods:
- Retrospective study of 30 fusion operations in 26 rheumatoid arthritis patients.
- Analysis of outcomes based on the type and location of cervical instability (atlanto-axial, cranial settling, subaxial).
Main Results:
- Fusion was performed for various types of cervical instability, including atlanto-axial, cranial settling, and subaxial.
- Neurological compromise improved or resolved in most patients following fusion, particularly with posterior fusion techniques.
- Two postoperative deaths occurred among the seven subaxial instability cases, specifically after anterior interbody fusions.
Conclusions:
- Immobilization through fusion is a primary treatment for neurological compromise in unstable rheumatoid cervical spines.
- Decompressive procedures may be unnecessary as an initial treatment, with fusion alone often achieving remission of symptoms.