The Surgical Treatment Principles of Atlantoaxial Instability Focusing on Rheumatoid Arthritis.
OBJECTIVE
This retrospective review was conducted to determine the surgical treatment principle for rheumatoid arthritis (RA) patients with atlantoaxial instability (AAI).


METHODS
Thirteen patients with AAI, including 5 RA patients, received preoperative computed tomography- (CT-) based image-guided navigation system (IGS) in C1 lateral mass-C2 pedicle screw-rod system fixation (LC1-PC2 fixation). These 13 patients were analyzed for 52 screws inserted into C1 and C2. We defined these patients as non-RA group (8 patients, 32 screws) and RA group (5 patients, 20 screws). The neurological status for RA group was evaluated using the Ranawat classification. The causes of AAI, surgical indications, complications, surgical method revolution, and CT-based navigation application are discussed.


RESULTS
None of the 13 patients expressed neurological function deterioration. The non-RA group screw accuracy was 100%. In the RA group, 1 RA patient developed left C2 screw loosening at 1(+) months after operation due to screw malposition. The screw accuracy for this group was 95%.


CONCLUSIONS
Higher intraoperative surgical complication rate was described in RA patients. Preoperative CT-based IGS in LC1-PC2 fixation can provide good neurological function and screw accuracy results. However, for higher screw accuracy in RA patients, intraoperative CT-based IGS application may be considered.
Department of Neurosurgery, Jen-Ai Hospital, No. 483 Dong Rong Road, Dali, Taichung 41265, Taiwan.
Yu-Tung
YT
Shih
Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan ; Graduate Institute of Medical Science, National Defense Medical Center, No. 161, Section 6, Minquan E. Road, Neihu District, Taipei 11490, Taiwan ; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, No. 79-9, Sha-Luen-Hu, Xi Zhou Li, Hou-Loung Town, Miaoli County 35664, Taiwan.
Ting-Hsien
TH
Kao
Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan ; Faculty of Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11266, Taiwan.
Hung-Chuan
HC
Pan
School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan ; Department of Orthopaedic Surgery, China Medical University Hospital, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan.
Hsien-Te
HT
Chen
Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Section 4, Taichung 40705, Taiwan ; Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, No. 79-9, Sha-Luen-Hu, Xi Zhou Li, Hou-Loung Town, Miaoli County 35664, Taiwan.
Hsi-Kai
HK
Tsou
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000601:surgery*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D025241:Spondylarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult