title: Neurological improvement and prognosis after occipito-thoracic fusion in patients with mutilating-type rheumatoid arthritis.
abstract: BACKGROUND
  Mutilating-type rheumatoid arthritis, the most aggressive type of rheumatoid arthritis, is frequently associated with destructive cervical involvement, both at the high-cervical and subaxial levels, causing significant neurological deficit, and their natural course of the disease and the survival are discouraging. For such cases, we have been actively performing occipito-thoracic fusion since 1991. Although medical treatment for rheumatoid patients has represented a marked improvement, it could not treat all of these patients because of several reasons. Therefore, it is still important to evaluate the past treatment results.
  
  
  METHODS
  We investigated the neurological improvement and prognosis in 51 mutilating-type rheumatoid arthritis patients who underwent occipito-thoracic fusion between 1991 and 2010. The neurological status was evaluated using modified Ranawat classification; class IIIB was subdivided into IIIBa (able to sit upright) and IIIBb (bedridden).
  
  
  RESULTS
  The preoperative neurologic status was IIIBa in 19 patients and IIIBb in 17 patients. 15 of the 19 patients with class IIIBa improved to being able to walk (79 %), whereas only 3 of the 17 patients with class IIIBb improved to being able to walk (18 %) after surgery. Of the 51 patients, 28 died during follow-up; the mean age at death was 67.2 years. The postoperative 5- and 10-year survival rates were 60.3 and 26.4 %, respectively.
  
  
  CONCLUSIONS
  The neurological improvement and prognosis after surgery was poorer in class IIIBb patients than in the other patient groups. Occipito-thoracic fusion can improve the neurological symptoms and prognosis. However, early surgical intervention is recommended, before a patient becomes bedridden (class IIIBb).
authors: Department of Orthopedic Surgery, Gunma Spine Center (Harunaso Hospital), 878-1 Kamitoyooka, Takasaki, Gunma 370-0871, Japan. teztano@gmail.com
authors: Tetsu
authors: T
authors: Tanouchi
authors: Takachika
authors: T
authors: Shimizu
authors: Keisuke
authors: K
authors: Fueki
authors: Masatake
authors: M
authors: Ino
authors: Naofumi
authors: N
authors: Toda
authors: Yasunori
authors: Y
authors: Tatara
authors: Nodoka
authors: N
authors: Manabe
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D001269:Atlanto-Occipital Joint; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery*; D011379:Prognosis; D020127:Recovery of Function; D013122:Spinal Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*