title: Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines.
abstract: METHODS
  A retrospective single-center study. We routinely have used C1-C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on mid-term results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions.
  
  
  METHODS
  Seventeen subjects (4 men, 13 women; mean age, 61 ± 9 years) with RA cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation, with at least 5 years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5 years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated.
  
  
  RESULTS
  The lesions included atlantoaxial subluxation (AAS, n = 6), AAS + vertical subluxation (VS, n = 7), and AAS + VS + subaxial subluxation (n = 4). There was significant neurological improvement at 2 years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5 years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5 years after surgery, were not significantly different. Major screw perforation rate was 2.1 %. No neural and vascular complications associated with screw insertion were observed.
  
  
  CONCLUSIONS
  Subjects with rheumatoid cervical lesions who underwent C1-C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2 years after surgery. However, there was a deterioration of this improvement at 5 years post surgery.
authors.affiliation: Department of Orthopaedic Surgery, Yodakubo Hospital, 2857 Furumachi, Nagawamachi, Chiisagatagun, Nagano, 386-0603, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Uehara
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Ogihara
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hirabayashi
authors.forename: Keijiro
authors.initials: K
authors.lastname: Mukaiyama
authors.forename: Shugo
authors.initials: S
authors.lastname: Kuraishi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shimizu
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Futatsugi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hashidate
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kato
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D016896:Treatment Outcome