title: Outcome of surgery for rheumatoid cervical spine at one institute over three decades.
abstract: BACKGROUND
  Surgical intervention is a therapeutic choice for atlantoaxial subluxation (AAS), vertical subluxation (VS), and subaxial subluxation (SAS) associated with rheumatoid cervical spine. However, the long-term outcomes of different subgroups remain unclear, although rheumatoid arthritis (RA) is a progressive disease even after surgery.
  
  
  OBJECTIVE
  To evaluate the outcomes of surgery for various subgroups of rheumatoid cervical spine, performed at a single institute over three decades.
  
  
  METHODS
  Retrospective clinical analysis.
  
  
  METHODS
  One-hundred eighteen seropositive RA patients treated at one institute over the past three decades. Atlantoaxial fixation was performed in 28 AAS patients. Occipitospinal fusion was performed in 41 irreducible AAS or VS patients. Laminotomy with autologous bone fusion was performed in 22 patients, anterior fusion in 5, laminoplasty in 4, and posterior decompression/fusion with instrumentation in 12 with SAS.
  
  
  METHODS
  Clinical outcomes using the Japanese Orthopedic Association score, complications, deterioration of RA, and mortality rate during the follow-up were investigated from preoperation to more than 10 years after surgery in the subgroups.
  
  
  METHODS
  Outcomes were compared among the subgroups.
  
  
  RESULTS
  Patients with AAS exhibited significantly better clinical outcomes throughout the follow-up period compared with patients from the other subgroups. Patients with SAS had the worst neurologic status even at preoperation, and the symptomatic improvement achieved by surgery deteriorated within less than 5 years. Deterioration of outcome was caused by occurrence of complications and deterioration of RA during the follow-up. The mortality rates at 5 and 10 years after surgery were 20% and 33%, respectively.
  
  
  CONCLUSIONS
  The outcome of surgery for rheumatoid cervical spine was different in the various subgroups and associated with the occurrence of complications and deterioration of RA.
authors.affiliation: Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, 3-1-1, Nishiochiai, Suma-ku, Kobe 654-0155, Japan. Electronic address: hiroshimiyamoto@hotmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sumi
authors.forename: Koki
authors.initials: K
authors.lastname: Uno
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Cervical spine; Outcome; Prognosis; Rheumatoid arthritis; Surgery