Document Detail

Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients.
MedLine Citation:
PMID:  19337758     Owner:  NLM     Status:  MEDLINE    
The most common cervical abnormality associated with rheumatoid arthritis (RA) is atlantoaxial subluxation, and atlantoaxial transarticular screw fixation has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation. Following C1-C2 fixation, however, subaxial subluxation reportedly can bring about neurological deterioration and require secondary operative interventions. Rheumatoid patients appear to have a higher risk, but there has been no systematic comparison between rheumatoid and non-rheumatoid patients. Contributing radiological factors to the subluxation have also not been evaluated. The objective of this study was to evaluate subaxial subluxation after atlantoaxial transarticular screw fixation in patients with and without RA and to find contributing factors. Forty-three patients who submitted to atlantoaxial transarticular screw fixation without any concomitant operation were followed up for more than 1 year. Subaxial subluxation and related radiological factors were evaluated by functional X-ray measurements. Statistical analyses showed that aggravations of subluxation of 2.5 mm or greater were more likely to occur in RA patients than in non-RA patients over an average of 4.2 years of follow-up, and postoperative subluxation occurred in the anterior direction in the upper cervical spine. X-ray evaluations revealed that such patients had a significantly smaller postoperative C2-C7 angle, and that the postoperative AA angle correlated negatively with this. Furthermore, anterior subluxation aggravation was significantly correlated with the perioperative atlantoaxial and C2-C7 angle changes, and these two changes were strongly correlated to each other. In conclusion, after atlantoaxial transarticular screw fixation, rheumatoid patients have a greater risk of developing subaxial subluxations. The increase of the atlantoaxial angel at the operation can lead to a decrease in the C2-C7 angle, followed by anterior subluxation of the upper cervical spine and possibly neurological deterioration.
Hiromu Ito; Masashi Neo; Takeshi Sakamoto; Shunsuke Fujibayashi; Hiroyuki Yoshitomi; Takashi Nakamura
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Publication Detail:
Type:  Journal Article     Date:  2009-04-01
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:  18     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-08     Completed Date:  2009-09-09     Revised Date:  2010-09-22    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  869-76     Citation Subset:  IM    
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
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MeSH Terms
Arthritis, Rheumatoid / complications*
Atlanto-Axial Joint / pathology,  radiography,  surgery*
Axis / pathology,  radiography,  surgery
Bone Screws / adverse effects
Cervical Atlas / pathology,  radiography,  surgery
Cervical Vertebrae / pathology,  radiography,  surgery*
Dislocations / etiology*,  pathology,  radiography
Postoperative Complications / etiology*,  pathology,  physiopathology
Radiculopathy / etiology,  pathology,  physiopathology
Spinal Cord Compression / etiology,  pathology,  physiopathology
Spinal Fusion / adverse effects*,  instrumentation,  methods
Spinal Stenosis / etiology,  pathology,  physiopathology
Stress, Mechanical
Weight-Bearing / physiology
Zygapophyseal Joint / pathology,  physiopathology

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