Document Detail

Atlanto-axial joint of atlanto-axial subluxation patients due to rheumatoid arthritis before and after surgery: morphological evaluation using CT reconstruction.
MedLine Citation:
PMID:  21038107     Owner:  NLM     Status:  MEDLINE    
This study investigated the preoperative morphology and postoperative fusion of the atlanto-axial joint (AAJ) in patients with atlanto-axial subluxation (AAS) due to rheumatoid arthritis (RA) using computed tomography (CT). Furthermore, we examined the relationship between the preoperative morphology of AAJ and other radiographic results. Thirty patients with AAS due to RA treated by C1-2 transarticular screw fixation (TSF) were reviewed. The morphology of the AAJ was evaluated using sagittal reconstruction views on CT before and 1 year after surgery. Thereafter, the atlanto-dental interval (ADI) value at the neutral and maximal flexion position and atlanto-axial angle (AAA) at the neutral position was assessed in preoperative lateral cervical radiographs. The preoperative morphology of the AAJ on CT reconstruction views was graded as follows: Grade 1 showed maintenance of the joint space, Grade 2 showed the joint space narrowing and Grade 3 showed the destructive abnormality of subchondral bone. After surgery, the ADI value at the neutral position was assessed in lateral cervical radiographs. Furthermore, the fusion in the AAJ was investigated using CT sagittal reconstruction views taken 1 year after surgery. The preoperative CT image of the AAJ demonstrated Grade 1 in 12 cases (Group A), Grade 2 in 9 cases (Group B) and Grade 3 in 9 cases (Group C). There was no significant difference in age, gender and duration of RA among the three groups. The average ADI value at the flexion position was 11.0 mm in Group A, 12.3 mm in Group B and 12.7 mm in Group C (p>0.313). The average ADI value at the neutral position before surgery was 4.5 mm in Group A, 7.3 mm in Group B and 11.4 mm in Group C (p<0.003). The mean AAA value was 20.8° in Group A, 21.8° in Group B and 8.4° in Group C (p<0.033). The average ADI value after TSF was 1.7 mm in Group A, 2.1 mm in Group B and 3.0 mm in Group C (p>0.144). Fusion in the AAJ 1 year after surgery was demonstrated in 14 cases (46.7%; Group A, 0 case; Group B, 5 cases; Group C, 9 cases). According to the preoperative grading of the AAJ, the postoperative fusion in the AAJ was demonstrated in 0 of 32 joints (0%) in Grade 1, 7 of 18 joints (38.9%) in Grade 2 and all of 10 joints (100%) in Grade 3. In conclusion, this study showed that a destructive abnormality of subchondral bone in the AAJ induced an enlargement of the ADI and anterior inclination of the atlas in patients with AAS due to RA. The current study also showed that fusion in the AAJ was demonstrated in 14 of 30 patients after C1/2 TSF. This was easy to recognize in AAS patients whose joint destruction extended to the subchondral bone.
Yasunori Sorimachi; Haku Iizuka; Tsuyoshi Ara; Masahiro Nishinome; Yoichi Iizuka; Takashi Nakajima; Kenji Takagishi
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Publication Detail:
Type:  Case Reports; Comparative Study; Journal Article     Date:  2010-11-01
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  20     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-04-27     Completed Date:  2012-03-26     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  798-803     Citation Subset:  IM    
Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
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MeSH Terms
Arthritis, Rheumatoid / pathology*,  radiography,  surgery
Atlanto-Axial Joint / pathology*,  radiography,  surgery
Image Processing, Computer-Assisted / methods*
Joint Instability / pathology*,  radiography,  surgery
Middle Aged
Retrospective Studies
Spinal Fusion / instrumentation,  methods*
Tomography, X-Ray Computed / methods*

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