Laminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis.
OBJECTIVE
Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of laminoplasty in such cases. To discuss indications for laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent laminoplasty for subaxial lesions.


METHODS
Thirty patients (11 men and 19 women) underwent laminoplasty for rheumatoid subaxial lesions. The patients were divided into those with mutilating-type rheumatoid arthritis (RA) and those with nonmutilating-type RA according to the number of eroding joints. As of final follow-up examination laminoplasty resulted in improvement of myelopathy in 24 patients (seven with mutilating- and 17 with nonmutilating-type RA) and transient or no improvement in six (five with mutilating- and one with nonmutilating-type RA). In the group with mutilating-type RA, significantly poorer results were displayed (p < 0.05). In most patients preoperative radiographs demonstrated vertebral slippage less than or equal to 5 mm at only one or two levels. Postlaminoplasty deterioration of subaxial subluxation and unfavorable alignment change occurred significantly more often in patients with mutilating-type RA (p < 0.05).


CONCLUSIONS
Patients with nonmutilating-type RA can benefit from laminoplasty for myelopathy due to subaxial lesions.
Mukai
Yoshihiro
Y
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan. mukai@ort.med.osaka-u.ac.jp
Hosono
Noboru
N
Sakaura
Hironobu
H
Ishii
Takahiro
T
Fuchiya
Tsuyoshi
T
Fijiwara
Keiju
K
Fuji
Takeshi
T
Yoshikawa
Hideki
H
D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000601:surgery*