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Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines.
- Source :
-
Journal of Orthopaedic Science . Nov2013, Vol. 18 Issue 6, p916-925. 10p. - Publication Year :
- 2013
-
Abstract
- Study design: A retrospective single-center study. Summary and background: 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. Objectives: 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- *RHEUMATOID arthritis
*NEUROLOGY
*NEUROLOGICAL disorders
*JOINT diseases
*SURGERY
Subjects
Details
- Language :
- English
- ISSN :
- 09492658
- Volume :
- 18
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- Journal of Orthopaedic Science
- Publication Type :
- Academic Journal
- Accession number :
- 92554387
- Full Text :
- https://doi.org/10.1007/s00776-013-0465-3