title: The clinical outcomes of atlanto-axial arthrodesis in patients with rheumatoid arthritis - Assessment according to the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical outcomes of atlanto-axial arthrodesis in rheumatoid arthritis (RA) patients with cervical myelopathy using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).
  
  
  METHODS
  Twenty patients who underwent surgery to treat atlanto-axial subluxation (AAS) were reviewed.
  
  
  RESULTS
  The rates of success rates for each domain were as follows: cervical spine function, 11 of 18 patients (61.1%); upper extremity function, 3 of 15 patients (20%); lower extremity function, 8 of 18 patients (44.4%); bladder function, 5 of 13 patients (38.5%); and quality of life, 3 of 20 patients (15%). Significant differences of success rate were found between the following domains: cervical spine function and upper extremity function, cervical spine function and the quality of life, and lower-extremity function and quality of life. There were significant differences in the pre- and post-surgery visual analogue scale (VAS) scores for pain or stiffness in the neck or shoulders, and pain or numbness in the arms and hands.
  
  
  CONCLUSIONS
  Atlanto-axial arthrodesis in RA patients provided a better outcome for cervical spine function, with improvement in VAS scores for pain or stiffness in the neck or shoulders. This surgery provided improvement of pain or numbness of the upper extremities but not of upper-extremity function. In contrast, the surgery achieved a relatively good recovery in lower-extremity function but little improvement of pain or numbness of the lower extremities. The success rate with regard to quality of life was found to be significantly lower than the success rates observed for cervical spine function and lower-extremity function.
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan. Electronic address: ihaku@gunma-u.ac.jp.
authors.forename: Haku
authors.initials: H
authors.lastname: Iizuka
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Iizuka
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan.
authors.forename: Tokue
authors.initials: T
authors.lastname: Mieda
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Tsunoda
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma 371-8511 Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sorimachi
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001174:Arthrodesis / Q000379:methods*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D004204:Joint Dislocations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012955:Societies, Medical; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome