Evaluation of posterior long fusion versus conservative treatment for the progressive rheumatoid cervical spine.
METHODS
Results of the posterior long fusion performed for the progressive cervical lesions of rheumatoid arthritis were compared with the outcomes of those who did not undergo surgical treatment.


OBJECTIVE
To provide a clue as to whether posterior long fusion improves or maintains the impaired daily life activity of the patients with rheumatoid arthritis with progressive, mutilating-type joint involvements.


BACKGROUND
To provide optimal treatments for the cervical lesions of patients with rheumatoid arthritis, the natural courses of cervical lesions should be taken into account. In the authors' preliminary study they have retrospectively investigated natural courses of cervical rheumatoid arthritis lesions and have found that the seropositive patients with rheumatoid arthritis with mutilating-type joint involvement are at a high risk of deteriorating the cervical lesion once their cervical spine becomes affected.


METHODS
In the present study 17 seropositive patients with rheumatoid arthritis with mutilating-type joint involvements were studied. Eleven patients underwent surgical treatments (operated group), whereas six patients did not (nonoperated group). All of the operated patients underwent occipitocervical or occipitocervicothoracic fusion supplemented by the Luque's sublaminar wiring and preoperative and postoperative usage of halo-jacket.


RESULTS
The six patients of the nonoperated group worsened the activities of daily living score and resulted in either complete bedridden or in death by the time point of final follow-up. In contrast, all of the 11 operated patients either improved or maintained the activities of daily living score: those operated because of neurologic compromise due to myelopathy improved at least one class in the activities of daily living score, and those operated because of severe occipitocervical pain maintained the activities of daily living with relief of pain.


CONCLUSIONS
The present study suggests that posterior long fusion may achieve an improvement of activities of daily living, at least, for a certain time period. However, the newly emerging lesions adjacent to the fused segments, which may result from the increased mechanical loads, may finally lead to the impairment of activities of daily living.
Omura
Kikuo
K
Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan. kk107360@mx.cable-net.ne.jp
Hukuda
Sinsuke
S
Katsuura
Akitomo
A
Saruhashi
Yasuo
Y
Imanaka
Toru
T
Imai
Shinji
S
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D016474:Weight-Bearing