title: Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis: comparison of occipitocervical fusion between c1 laminectomy and nonsurgical management.
abstract: METHODS
  A matched controlled comparative study of patients with upper cervical lesions caused by rheumatoid arthritis was performed at two different hospitals to evaluate occipitocervical fusion associated with C1 laminectomy and nonsurgical treatment.
  
  
  OBJECTIVE
  To evaluate the long-term results and advantages of occipitocervical fusion associated with C1 laminectomy, and to compare these results with those of nonsurgical management of patients with myelopathy related to rheumatoid arthritis.
  
  
  BACKGROUND
  Few studies have reported the prognosis of patients with rheumatoid arthritis managed by occipitocervical fusion associated with C1 laminectomy.
  
  
  METHODS
  In this study, 40 patients with rheumatoid arthritis and myelopathy caused by irreducible atlantoaxial dislocation with or without upward migration of the odontoid process were studied. Of these 40 patients, 19 were treated by occipitocervical fusion using a rectangular rod associated with C1 laminectomy at one hospital, whereas 21 matched patients were treated conservatively at another hospital. The patients were observed by the same protocol to assess the radiologic and clinical results, including functional recovery and survival rate. All the patients were followed until their death.
  
  
  RESULTS
  The atlantodental interval was reduced immediately after surgery, and this result had been well maintained at the final follow-up assessment. Redlund-Johnell values did not vary significantly throughout the course of the study. As for neural assessment with the Ranawat classification system, improvement was found in 13 (68%) of the 19 patients who underwent surgery. The survival rate was 84% 5 years after surgery, and 37% in the first 10 years. In the patients who did not undergo surgical treatment, atlantodental interval and Redlund- Johnell values were aggravated. These patients showed no neural improvement, and aggravation was found in 16 (76%) of the 21 cases during the follow-up period. All the patients were bedridden within 3 years after the onset of myelopathy. The survival rate was 0% in the first 8 years.
  
  
  CONCLUSIONS
  The findings lead to the conclusion that occipitocervical fusion associated with C1 laminectomy for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima City, Japan. shunji @ m.kufm.kagoshima-u.ac.jp
authors.forename: Shunji
authors.initials: S
authors.lastname: Matsunaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakou
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onishi
authors.forename: Kyoji
authors.initials: K
authors.lastname: Hayashi
authors.forename: Eiji
authors.initials: E
authors.lastname: Taketomi
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Sunahara
authors.forename: Setsuro
authors.initials: S
authors.lastname: Komiya
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001268:Atlanto-Axial Joint / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013118:Spinal Cord Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013122:Spinal Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome