title: Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine.
abstract: OBJECTIVE
  This is a retrospective study of the outcome of occipitothoracic fusion surgery in rheumatoid arthritis (RA) patients with destruction of the cervical spine, designed to assess the efficacy of halo vest before surgery, the postoperative outcome, and the activities-of-daily living (ADL) problems associated with surgical management. There have been no reports regarding these issues, including surgical effect on subjacent vertebrae.
  
  
  METHODS
  This study included 20 RA patients with destruction of the cervical spine. All patients underwent preoperative halo vest followed by occipitothoracic fusion with an average follow-up of 5 years. The long-term clinical outcomes were analyzed using a modified Ranawat classification.
  
  
  RESULTS
  Before halo application, the neurologic status was assessed as IIIC in 15 patients and IIIB in 5 patients. After halo application, the neurologic status improved in all patients: IIIA in 12 patients and IIIB in 8 patients. After surgery, the neurologic status did not improve in six of the eight IIIB patients but improved to IIIA in two patients. Of the 12 IIIA patients, the neurologic status improved to II in 6 patients but did not improve in the other 6 patients. Patient satisfaction was excellent for 14 patients, good for 3 patients, and fair for only 3 patients (1 had difficulty drinking, another had back pain, and the last had low back pain associated with a compression fracture of the lumbar spine).
  
  
  CONCLUSIONS
  We have performed occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. Preoperative halo vest was very effective for improving the neurologic status, for the general condition, and for an optimal sagittal alignment. Occipitothoracic fusion using unit rods gave satisfactory long-term clinical results compared with the prognosis of patients in whom the disease follows its natural course.
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Nagoya University School, Nagoya, Japan. spine-yu@tsuru.med.nagoya-u.ac.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawakami
authors.forename: Hisatake
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Taichi
authors.initials: T
authors.lastname: Tsuji
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiya
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Yukawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016267:External Fixators / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards*; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D009777:Occipital Bone / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D025241:Spondylarthritis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome