title: Surgical complications and management of occipitothoracic fusion for cervical destructive lesions in RA patients.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  The objective of this study is to evaluate the clinical outcome of occipitothoracic fusion for severe destructive cervical lesions in rheumatoid arthritis (RA) patients with myelopathy and/or occipitocervical pain, and to discuss surgical complications. The complication rates are compared between 2 groups treated with different instrumentation techniques.
  
  
  BACKGROUND
  Few studies have reported on the results of occipitothoracic fusion in RA patients.
  
  
  METHODS
  In this study, 56 RA patients with myelopathy and/or occipitocervical pain caused by destructive cervical lesions were studied. The patients were divided into 2 groups A and B, according to the used rod diameter and the application of the cervical pedicle screw system. Group A included 38 patients treated with Unit rods (4.75 mm). Group B included 18 patients treated with cervical pedicle screw system (3.2 mm or 3.5 mm diameter rod). Clinical results and surgical complications were evaluated.
  
  
  RESULTS
  Mean follow-up time was 36.2 months. Fifteen patients died during follow-up at the mean age of 67.3 years. None died from their cervical lesions. The neurologic status in 46 patients (82%) had improved at least 1 class in the modified Ranawat scale. Perioperative complications occurred in 16 (28.6%), thoracic spine lesions in 11 (19.6%), implant failure in 13 (23.2%), and surgical site infection in 8 (14.3%). There was a tendency for more fractures and pedicle screw pullouts at the lowest level of the fusion area to occur in group B. The neurologic improvement of patients undergoing occipitothoracic fusion after becoming unable to sit owing to their neurologic deficit was poor.
  
  
  CONCLUSIONS
  The current study suggests that occipitothoracic fusion for rheumatoid destructive cervical lesions can be effective in improving neurologic deficit if performed while patients can still sit. Improvements to methodology of this surgery can be made.
authors.affiliation: Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan. khirano@med.nagoya-u.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirano
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sakai
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Katayama
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Wakao
authors.forename: Hisatake
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miura
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Kamiya
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D009777:Occipital Bone / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods* / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000453:epidemiology; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome