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Risk factors for development of subaxial subluxations following atlantoaxial arthrodesis for atlantoaxial subluxations in rheumatoid arthritis.
- Source :
-
Spine [Spine (Phila Pa 1976)] 2010 Jul 15; Vol. 35 (16), pp. 1551-5. - Publication Year :
- 2010
-
Abstract
- Study Design: Retrospective radiographic/imaging study.<br />Objective: To evaluate preoperative and sequential postoperative radiographs following C1-C2 arthrodesis for atlantoaxial subluxation in patients with rheumatoid arthritis (RA) to determine risk factors for the development of subaxial subluxations (SAS).<br />Summary of Background Data: The development of SAS has often been observed after C1-C2 arthrodesis. However, there have been no previous reports on the correlation between radiographic parameters and the incidence of postoperative SAS.<br />Methods: The study group comprised of 58 patients with RA who underwent C1-C2 arthrodesis due to atlantoaxial subluxation. There were 5 men and 53 women with a mean age of 55.8 years. The mean follow-up period was 137 months. Nineteen patients with a postoperative SAS after C1-C2 arthrodesis were classified as the SAS+ group. Other 39 patients without a postoperative SAS were included in the SAS- group. Clinical outcomes and plain radiographs were reviewed retrospectively and compared between the 2 groups.<br />Results: The difference between pre- and postoperative atlantoaxial (AA) angles in the SAS+ group was significantly greater than those in the SAS- group (P = 0.039). The C2-C7 angles changed significantly between pre- and postoperative periods in the SAS+ group (P = 0.039), but not in the SAS- group (P = 0.897). It was suggested that a large AA angle and a small C2-C7 angle observed at the early postoperative period were the risk factors for the development of SAS. We also demonstrated that a high incidence of the C3-C4 SAS resulted from excessive bone fusion at the C2-C3.<br />Conclusion: Excessive correction of AA angle is likely to cause loss of cervical lordosis, resulting in the development of postoperative SAS. In addition, extensive bony union at C2-C3 following C1-C2 arthrodesis frequently leads to the development of extensive SAS at the C3-C4.
- Subjects :
- Adult
Aged
Arthritis, Rheumatoid diagnostic imaging
Arthritis, Rheumatoid pathology
Atlanto-Axial Joint diagnostic imaging
Atlanto-Axial Joint pathology
Cervical Atlas diagnostic imaging
Cervical Atlas pathology
Cervical Atlas surgery
Cervical Vertebrae diagnostic imaging
Cervical Vertebrae pathology
Disease Progression
Female
Humans
Joint Dislocations diagnostic imaging
Joint Dislocations pathology
Joint Instability diagnostic imaging
Joint Instability pathology
Male
Middle Aged
Postoperative Complications diagnostic imaging
Postoperative Complications pathology
Radiography
Retrospective Studies
Risk Factors
Spinal Curvatures diagnostic imaging
Spinal Curvatures etiology
Spinal Curvatures pathology
Spinal Fusion adverse effects
Spinal Fusion methods
Young Adult
Arthritis, Rheumatoid surgery
Atlanto-Axial Joint surgery
Cervical Vertebrae surgery
Joint Dislocations surgery
Joint Instability surgery
Postoperative Complications etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1159
- Volume :
- 35
- Issue :
- 16
- Database :
- MEDLINE
- Journal :
- Spine
- Publication Type :
- Academic Journal
- Accession number :
- 20072093
- Full Text :
- https://doi.org/10.1097/BRS.0b013e3181af0d85