Document Detail


Is rheumatoid arthritis a risk factor for a high-riding vertebral artery?
MedLine Citation:
PMID:  18708934     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A retrospective comparative study on the morphologic characteristics of the axis in patients with or without rheumatoid arthritis (RA). OBJECTIVE: To compare the morphologic risk of vertebral artery (VA) injury during atlantoaxial transarticular screw fixation between patients with or without RA. SUMMARY OF BACKGROUND DATA: VA injury is a potentially serious complication during atlantoaxial transarticular screw fixation. Although this operation is frequently performed on RA patients, there have been few comparative studies on the morphologic risk of VA injury between RA and non-RA patients. METHODS: A total of 107 three-dimensional computed tomography images of the cervical spine including the C1-C2 complex were evaluated. Forty-seven RA patients and 60 non-RA patients were included in the study. The maximum atlantoaxial transarticular screw diameter (MSD) that could be inserted without breaching the cortex was measured 3-dimensionally using a computer- assisted navigation system. A high-riding-VA carrier was defined as a patient with either MSD of 4 mm or less. In RA patients, the space available for the spinal cord in flexion (SAC in flexion), duration of disease, RA stage, and type of disease were examined. RESULTS: In the RA group, 45 of 94 MSDs (47.9%) were 4 mm or less, and 33 of 47 patients (70.2%) were high-riding-VA carriers. In the non-RA group, 11 of 120 MSDs (9.2%) were 4 mm or less, and 9 of 60 (15.0%) patients were high-riding-VA carriers. MSD, C3 A-P diameter, and the ratio of MSD to C3 A-P diameter were significantly smaller in the RA group than in the non-RA group. Multiple logistic regression analysis showed that SAC in flexion was a significant risk factor for a high-riding-VA carrier in the RA group. CONCLUSION: RA was a significant risk factor for the presence of a high-riding VA. When performing atlantoaxial transarticular screw fixation, particularly on RA patients, thorough preoperative evaluation of the bony architecture is of great importance to avoid inadvertent VA injury.
Authors:
Masahiko Miyata; Masashi Neo; Hiromu Ito; Makoto Yoshida; Koichi Miyaki; Shunsuke Fujibayashi; Takeo Nakayama; Takashi Nakamura
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Spine     Volume:  33     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-18     Completed Date:  2009-02-20     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2007-11     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. miyatch@kuhp.kyoto-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid / complications*,  radiography*,  surgery
Atlanto-Axial Joint / radiography,  surgery
Bone Screws / adverse effects
Female
Humans
Intraoperative Complications / etiology,  prevention & control
Male
Middle Aged
Retrospective Studies
Risk Factors
Spinal Fusion / adverse effects,  instrumentation
Vertebral Artery / radiography*,  surgery

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


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