Document Detail

Effect of a reduction of the atlanto-axial angle on the cranio-cervical and subaxial angles following atlanto-axial arthrodesis in rheumatoid arthritis.
MedLine Citation:
PMID:  23277297     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We retrospectively investigated the radiographic findings in patients with atlanto-axial subluxation (AAS) due to rheumatoid arthritis, and clarified the effect of reduction of the atlanto-axial angle (AAA) on the cranio-cervical and subaxial angles.
METHODS: Forty-one patients, consisting of 29 females and 12 males, with AAS treated by surgery were reviewed. The average patient age at surgery was 61.0 years, and the average follow-up period was 4.0 years. We investigated the AAA at the neutral position in lateral cervical radiographs before surgery and at the last follow-up. In addition, we also investigated the clivo-axial angle (CAA) and the subaxial angle (SAA) at the neutral position before and after surgery.
RESULTS: Due to pre-operative AAA, the patients were classified into three groups as follows: (1) the kyphotic group (K group), (2) the neutral group (N group), and (3) the lordotic group (L group). The average AAA values at the neutral position in the K group before and after surgery were 6.0° and 18.1°, respectively (P < 0.001). In the N group 19.7° and 21.7°, respectively (P < 0.05), and in the L group 31.6° and 27.0°, respectively (P < 0.01). However, no significant differences in the average CAA values were found before and after surgery in all groups. Furthermore, no significant differences in the SAA values were seen before and after surgery in all groups.
CONCLUSIONS: A proper reduction of the AAA did not affect the cranial angles or induce kyphotic malalignment of the subaxial region after atlanto-axial arthrodesis. However, if we can obtain a significant and large reduction of AAA in patients showing kyphosis before surgery, then this reduction will be offset in the atlanto-occipital joint and we should therefore pay special attention to its morphology after surgery.
Haku Iizuka; Yoichi Iizuka; Ryoichi Kobayashi; Yasuhiko Takechi; Masahiro Nishinome; Tsuyoshi Ara; Yasunori Sorimachi; Takashi Nakajima; Kenji Takagishi
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Publication Detail:
Type:  Journal Article     Date:  2013-01-01
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:  22     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-20     Completed Date:  2013-12-30     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1137-41     Citation Subset:  IM    
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MeSH Terms
Arthritis, Rheumatoid / radiography,  surgery*
Atlanto-Axial Joint / radiography,  surgery*
Atlanto-Occipital Joint / radiography,  surgery
Joint Instability / radiography,  surgery*
Middle Aged
Range of Motion, Articular
Retrospective Studies
Spinal Fusion / methods*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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