[Occipitocervical fusion in chronic polyarthritis]

Area of Science:

• Orthopedics
• Neurosurgery
• Rheumatology

Background:

• Rheumatoid arthritis frequently causes occipitocervical instability and basilar invagination.
• These conditions can lead to severe neck pain, myelopathy, and spinal cord compression.
• Surgical intervention is often necessary for decompression and stabilization.

Purpose of the Study:

• To evaluate the effectiveness of y-plate occipitocervical fusion in treating rheumatoid arthritis patients.
• To assess pain reduction, functional outcomes, and fusion rates.
• To determine the role of transoral dens resection in conjunction with fusion.

Main Methods:

• Retrospective analysis of 39 rheumatoid arthritis patients undergoing occipitocervical fusion with a y-plate (1987-1994).
• Indications included occipitocervical instability, basilar invagination, and spinal cord decompression.
• Surgical techniques involved varying fusion lengths and integration of atlantoaxial screws; some cases required transoral dens resection.

Main Results:

• Significant reduction in average pain scores from 8.1 to 2.3 post-surgery.
• High fusion rate of 96.9% despite implant-related complications (3 breakages, 2 loosenings).
• Satisfying outcomes (Conaty criteria) in 75% of patients; myelopathy resolved in most cases.

Conclusions:

• Occipitocervical fusion using the y-plate is an effective treatment for rheumatoid arthritis patients with cervical spine instability.
• The technique provides significant pain relief and functional improvement.
• Transoral dens resection is reserved for cases with severe basilar invagination or irreducible instability.