title: C1-C2 intra-articular screw fixation for atlantoaxial subluxation due to rheumatoid arthritis.
abstract: While various surgical procedures have been developed for the treatment of atlantoaxial subluxation due to rheumatoid arthritis, C1-C2 intra-articular screw fixation was developed to reduce intraoperative injuries to vertebral arteries. The purpose of this study was to report the therapeutic outcome of this procedure, which was followed for >2 years. Preoperative symptoms were alleviated in all patients. Only 1 patient with subaxial canal stenosis underwent additional laminoplasty during follow-up. All patients with class IIIA or milder neural deficit according to Ranawat's classification showed improvement to class I or II. There were no surgery-related complications or incidents, including injuries to vertebral arteries. Bone union was observed in all patients. No change was observed in the reduced atlas-dens interval during follow-up. The atlantoaxial angle was -6 degrees to 30 degrees (average, 19.4 degrees) at follow-up, and was >or=30 degrees after surgery (fusion in an overextended position) in only 1 patient. Although postoperative deterioration of cervical alignment was observed in 4 patients (18.2%), there was no additional surgery due to deterioration of cervical alignment. With no surgery-related complications or incidents, this procedure could be a safe and acceptable option for atlantoaxial subluxation due to rheumatoid arthritis.
authors.affiliation: Department of Orthopedic Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tokuhashi
authors.forename: Yasumitsu
authors.initials: Y
authors.lastname: Ajiro
authors.forename: Masashi
authors.initials: M
authors.lastname: Oshima
authors.forename: Natsuki
authors.initials: N
authors.lastname: Umezawa
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D016348:Osseointegration; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome