Principles of surgical treatment of the cervical spine in rheumatoid arthritis.
About 20% of patients with rheumatoid arthritis complain about neck problems based on instability and deformity. As a consequence, pain, myelopathy, and severe neurological deficit may occur. Results reported in the literature were not encouraging as regards surgical decompression and stabilization. However, new surgical techniques allow a more aggressive strategy towards the complex problem of the instable cervical spine in rheumatoid arthritis. The most frequent instability of C1/2 can be stabilized by a posterior atlantoaxial screw fixation, a three-dimensional multidirectional construct with few complications. For the inclusion of the occiput into the fusion and the extension of the fusion down to the lower cervical spine, a titanium Y-plate is presented as a successful implant. While through a posterior approach, stability may be achieved, decompression is preferably done by anterior diskectomy or vertebrectomy. Encouraging results with a significant recovery of neurological deficits justify an early intervention in cases of instability of the cervical spine in rheumatoid arthritis.
Grob
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Schulthess Klinik, Neumünsterallee 3, CH-8008 Zürich, Switzerland.
D001172:Arthritis, Rheumatoid / Q000150:complications*; D001860:Bone Plates; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods