1
|
Jackson-Fowl B, Hockley A, Naessig S, Ahmad W, Pierce K, Smith JS, Ames C, Shaffrey C, Bennett-Caso C, Williamson TK, McFarland K, Passias PG. Adult cervical spine deformity: a state-of-the-art review. Spine Deform 2024; 12:3-23. [PMID: 37776420 DOI: 10.1007/s43390-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2023] [Indexed: 10/02/2023]
Abstract
Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.
Collapse
Affiliation(s)
- Brendan Jackson-Fowl
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Edmonton, AB, USA
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler K Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Kimberly McFarland
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| |
Collapse
|
2
|
Wróblewski R, Koszela K, Mańczak M, Sudoł-Szopińska I, Gasik R. Relationship between Cervical Instability in the Course of Rheumatoid Arthritis and Pelvic Parameters of Sagittal Balance. J Clin Med 2023; 12:6507. [PMID: 37892648 PMCID: PMC10607725 DOI: 10.3390/jcm12206507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim of the study is to search for a relationship between cervical instability in the course of rheumatoid arthritis (RA) and pelvic parameters of sagittal balance and lumbar lordosis (LL). METHODS The study included 47 patients with rheumatoid arthritis with instability of the cervical segment, who were referred for a consultation to assess indications for surgical treatment. The patients underwent a radiological functional examination of the cervical region and postural examination of the entire spine. The basic parameters of the lumbar section and pelvis of these patients were compared with the population values. Then, using statistical methods, the correlation between radiological parameters of various types of instability and lumbar lordosis (LL), pelvic parameters (PI, SS, PT), as well as the patient's age and duration of the disease was assessed. RESULTS A statistical correlation was found between the instability in the cervical spine C2-C3 level and the value of the PT and PI angles. A statistically significant correlation was discovered between C1-C2 instability and younger patient age. There was no significant difference in the values of the pelvic parameters and lumbar lordosis in patients with rheumatoid arthritis compared to the population values. CONCLUSIONS Preliminary results suggest that there is a relationship between selected pelvic parameters and the development of instability in patients with rheumatoid arthritis. This may be important in planning treatment and assessing disease progression. Further studies on a larger group of patients are needed, as well as studies evaluating the correlation between other sagittal balance parameters and cervical instability in patients with RA.
Collapse
Affiliation(s)
- Robert Wróblewski
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Robert Gasik
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| |
Collapse
|
3
|
Le Quellec A, Guyard T, Carvajal Alegria G, Ruyssen-Witrand A, Fautrel B, Flipo RM, Garrigues F, Saraux A. Prevalence and predictors of atlanto-axial subluxation in rheumatoid arthritis after 12-years' follow-up (ESPOIR Cohort). Rheumatology (Oxford) 2023; 62:2692-2699. [PMID: 36440910 DOI: 10.1093/rheumatology/keac672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/19/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Anterior atlanto-axial subluxation (AAS), defined as an anterior atlanto-dental interval ≥3 mm, can occur in RA and carries a risk of severe neurological impairments. Our objective was to determine the prevalence and predictors of radiographic aAAS after 12 years' follow-up of patients with early polyarthritis. METHODS We studied patients enrolled in the early polyarthritis cohort ESPOIR (Study and Monitoring of Early Undifferentiated Arthritis) between 2002 and 2005 (at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA, and no previous exposure to glucocorticoids or DMARDs). All patients still in the cohort after 12 years had dynamic cervical-spine radiographs taken then read by two blinded observers. To evaluate how well combinations of tests performed at baseline and 10 years predicted aAAS after 12 years, univariate analysis and multiple logistic regression procedure were applied. RESULTS Of 323 patients followed for 12 years, 15 (4.6%; 95% CI 2.8, 6.4) had aAAS. Among baseline variables, only IgA RFs were associated (P < 0.05) with aAAS (sensitivity 60%, specificity 75%). Among data collected after 10 years, oral CS therapy during the 10-year interval, treatment by DMARDs, CRP (mg/dl) and positive tests for RFs were associated with aAAS after 12 years, but only CRP and RFs remained in a model of logistic regression (combination predicted aAAS with a sensitivity of 60% for a specificity of 90%). CONCLUSION In conclusion, the prevalence of aAAS after 12 years was 4.6% in the ESPOIR cohort, with no patients having severe aAAS. Although some factors were found to be statistically associated to AAS, the event is too rare to allow a clinical relevance.
Collapse
Affiliation(s)
| | | | | | - Adeline Ruyssen-Witrand
- Centre de Rhumatologie, CHU Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, University of Toulouse 3, Toulouse, France
| | - Bruno Fautrel
- Sorbonne Université - APHP, Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France
- INSERM U1136, Paris, France
| | | | | | - Alain Saraux
- Service de Rhumatologie, CHU Brest, Brest, France
- Université de Bretagne Occidentale, INSERM (U1227), LabEx IGO, Brest, France
| |
Collapse
|
4
|
Yankey KP, Duah HO, Sacramento-Domínguez C, Tutu HO, Owiredu MA, Mahmud R, Wulff I, Ofori-Amankwah G, Akoto H, Boachie-Adjei O. The Effect of Prolonged Pre-Operative Halo Gravity Traction for Severe Spinal Deformities on the Cervical Spine Radiographs. Global Spine J 2023; 13:451-456. [PMID: 33678056 PMCID: PMC9972284 DOI: 10.1177/2192568221998644] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review of consecutive series. OBJECTIVE The study sought to assess the effect of prolonged pre-operative halo gravity traction (HGT) on the c-spine radiographs. METHODS Data of 37 pediatric and adult patients who underwent ≥ 12wks pre-op HGT prior to definitive spine surgery from 2013-2015 at a single site in West Africa was reviewed. Radiographic assessment of the c-spine including ADI, SVA and C2-C7 Lordosis were done at pre HGT and at 4 weekly intervals. Paired T-Test was performed to evaluate changes in these parameters during HGT. RESULTS 37pts, 18/19 (F/M). Average age 18.2yrs. Diagnoses: 22 idiopathic, 6 congenital, 3 Post TB, 2 NM and 4 NF. Average duration of HGT: 125 days. Baseline coronal Cobb:130 deg, corrected 30% in HGT; baseline sagittal Cobb:146 deg, corrected 32% post HGT. Baseline ADI (3.17 ± 0.63 mm) did not change at 4wks (P > 0.05) but reduced at 8wks (2.80 ± 0.56 mm) and 12wks (2.67 ± 0.51 mm) post HGT (P < 0.05). Baseline HGT SVA (20.7 ± 14.98 mm) significantly improved at 4wks (11.55 ± 10.26 mm), 8wks (7.54 ± 6.78 mm) and 12wks (8.88 ± 4.5 mm) (P < 0.05). Baseline C2-C7 lordosis (43 ± 20.1 deg) reduced at 4wks (26 ± 16.37 deg), 8wks (17.8 ± 14.77 deg) and 12wks (16.7 ± 11.33 deg) post HGT (P < 0.05). There was no incidence of atlanto-axial instability on flexion extension radiographs at any interval. CONCLUSION Prolonged HGT, while providing partial correction of severe spine deformities, also appeared to have no adverse effect on atlanto-axial stability or cervical alignment. Therefore, HGT can be safely applied for several weeks in the preoperative management of severe spine deformities in pediatric/adult patients.
Collapse
Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, Accra,
Ghana,Henry Ofori Duah, FOCOS Orthopaedic
Hospital, No. 8 Teshie Street, Pantang, Accra. P. O. Box KD 779, Accra, Ghana.
Emails: ;
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Zoli A, Leone F, Zoli A, Visocchi M. Rheumatoid Diseases Involving the Cervical Spine I. History, Definition, and Diagnosis: New Trends and Technologies. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:197-202. [PMID: 38153469 DOI: 10.1007/978-3-031-36084-8_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The cervical spine might be involved in several conditions: congenital, traumatic, and chronic inflammatory and or degenerative rheumatic disorders. Among the inflammatory rheumatic conditions that can affect the cervical spine, rheumatoid arthritis (RA) is the most common, affecting up to 86% of patients and leading to cervical spine instability and subsequent myelopathy. Other inflammatory diseases include juvenile idiopathic arthritis (JIA) and the spondyloarthritis group (SpA), including psoriatic arthritis. Since many patients do not show symptoms of cervical involvement, diagnosis is often delayed. Radiographs are the first line imaging modality used to detect such involvement, but MRI and CT are superior in terms of early diagnosis and surgical planning.In this review, we provide an overview of cervical involvement in RA, JIA, and SpA.
Collapse
Affiliation(s)
- Andrea Zoli
- UOC di Reumatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Flavia Leone
- UOC di Reumatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Zoli
- UOC di Reumatologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
6
|
Chang CC, Wu JC, Ko CC, Chang HK, Kuo YH, Kuo CH, Tu TH, Huang WC. Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy. Neurospine 2022; 19:889-895. [PMID: 36597625 PMCID: PMC9816601 DOI: 10.14245/ns.2244786.393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/28/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Diseases of the craniovertebral junction (CVJ) are commonly associated with deformity, malalignment, and subsequent myelopathy. The misaligned CVJ might cause compression of neuronal tissues and subsequently clinical symptoms. The triangular area (TA), measured by magnetic resonance imaging/images (MRI/s), is a novel measurement for quantification of the severity of compression to the brain stem. This study aimed to assess the normal and pathological values of TA by a comparison of patients with CVJ disease to age- and sex-matched controls. Moreover, postoperative TAs were correlated with outcomes. METHODS Consecutive patients who underwent surgery for CVJ disease were included for comparison to an age- and sex-matched cohort of normal CVJ persons as controls. The demographics, perioperative information, and pre- and postoperative 2-year cervical MRIs were collected for analysis. Cervical TAs were measured and compared. RESULTS A total of 201 patients, all of whom had pre- or postoperative MRI, were analyzed. The TA of the CVJ deformity group was larger than the healthy control group (1.62 ± 0.57 cm2 vs. 1.01 ± 0.18 cm2, p < 0.001). Moreover, patients who had combined anterior odontoidectomy and posterior laminectomy with fixation had the greatest reduction in the TA (1.18 ± 0.58 cm2). CONCLUSION In CVJ deformity, the measurement of the cervical TA could indicate the severity of brain stem compression. After surgery, the TA had a varying degree of improvement, which could represent the efficacy of surgery.
Collapse
Affiliation(s)
- Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan,Department of BioMedical Engineering, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan,Department of BioMedical Engineering, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan,Corresponding Author Tsung-Hsi Tu Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| |
Collapse
|
7
|
Palmisciano P, Al Fawares Y, Woodhouse C, Yang G, Xu A, d'Herbemont S, Hoang S, McGuire JL, Phillips KM, Cheng J, Forbes JA. The Impact of C1 Anterior Arch Preservation on Spine Stability After Odontoidectomy: Systematic Review and Meta-Analysis. World Neurosurg 2022; 167:165-175.e2. [PMID: 36049722 DOI: 10.1016/j.wneu.2022.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Odontoidectomy for symptomatic irreducible ventral brainstem compression at the craniovertebral junction may result in spine instability requiring subsequent instrumentation. There is no consensus on the importance of C1 anterior arch preservation in prevention of iatrogenic instability. We conducted a systematic review of the impact of C1 anterior arch preservation on postodontoidectomy spine stability. METHODS PubMed, Embase, Scopus, Web of Science, and Cochrane were searched following the PRISMA guidelines to include studies of patients undergoing odontoidectomy. Random-effect model meta-analyses were performed to compare spine stability between C1 anterior arch preservation versus removal and posttreatment outcomes between transoral approaches (TOAs) versus endoscopic endonasal approaches (EEAs). RESULTS We included 27 studies comprising 462 patients. The most common lesions were basilar invagination (73.3%) and degenerative arthritis (12.6%). Symptoms included myelopathy (72%) and neck pain (43.9%). Odontoidectomy was performed through TOA (56.1%) and EEA corridors (34.4%). The C1 anterior arch was preserved in 16.7% of cases. Postodontoidectomy stabilization was performed in 83.3% patients. Median follow-up was 27 months (range, 0.1-145). Rates of spine instability were significantly lower (P = 0.004) when the C1 anterior arch was preserved. Postoperative clinical improvement and pooled complications were reported in 78.8% and 12.6% of patients, respectively, with no significant differences between TOA and EEA (P = 0.892; P = 0.346). Patients undergoing EEA had significantly higher rates of intraoperative cerebrospinal fluid leaks (P = 0.002). CONCLUSIONS Odontoidectomy is safe and effective for treating craniovertebral junction lesions. Preservation of the C1 anterior arch seems to improve maintenance of spine stability. TOA and EEA show comparable outcomes and complication rates.
Collapse
Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yara Al Fawares
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Cody Woodhouse
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, USA
| | - George Yang
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alice Xu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sophie d'Herbemont
- Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico
| | - Stanley Hoang
- Department of Neurosurgery, Ochsner LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Jennifer L McGuire
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jonathan A Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| |
Collapse
|
8
|
Ellatif M, Sharif B, Baxter D, Saifuddin A. Update on imaging of the cervical spine in rheumatoid arthritis. Skeletal Radiol 2022; 51:1535-1551. [PMID: 35146552 DOI: 10.1007/s00256-022-04012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.
Collapse
Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK.
| | - Ban Sharif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
| | - David Baxter
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
9
|
Chuang TL, Chou SC, Chen YR, Wang YF. Bone Scan With SPECT/CT Demonstrated C1 to C2 Involvement in Rheumatic Arthritis. Clin Nucl Med 2022; 47:661-663. [PMID: 35452005 PMCID: PMC9169756 DOI: 10.1097/rlu.0000000000004160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
ABSTRACT An 80-year-old man was treated with rituximab for active rheumatoid arthritis until 2019, now controlled with Salazopyrin, prednisolone, methotrexate, and folic acid. However, laboratory data showed elevated C-reactive protein and erythrocyte sedimentation rate. Whole-body bone scan showed bony and joint destruction to the upper cervical vertebra (C spine), bilateral shoulders, wrists, finger joints, ankles, and left knee. SPECT/CT localized the upper C spine uptake to the C1/C2 joint and adjacent C1 and C2 with C1/C2 subluxation. C spine CT showed vertical atlantoaxial subluxation and bony erosions.
Collapse
Affiliation(s)
- Tzyy-Ling Chuang
- From the Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| | - Shih-Chin Chou
- Department of Nuclear Medicine, Chi Mei Medical Center, Liouying
| | - Yu-Ruei Chen
- Department of Medical Imaging, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yuh-Feng Wang
- From the Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| |
Collapse
|
10
|
Benigno UE, Giammalva GR, Basile L, Iacopino DG, Maugeri R. Letter to the Editor Regarding “Biologic Agents Preserve the C-2 Pedicle in Patients with Rheumatoid Arthritis: A Comparative Imaging Study Using Three-Dimensional Computed Tomography”. World Neurosurg 2022; 160:116-117. [DOI: 10.1016/j.wneu.2021.12.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022]
|
11
|
Mamaril-Davis JC, Aguilar-Salinas P, Avila MJ, Villatoro-Villar M, Dumont TM. Perioperative management of disease-modifying antirheumatic drugs for patients undergoing elective spine surgery: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:815-829. [PMID: 35132461 DOI: 10.1007/s00586-021-07080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In preparation for surgery, patients being treated with disease-modifying antirheumatic drugs (DMARDs) are recommended to either continue or withhold therapy perioperatively. Some of these drugs have known effects against bone healing, hence the importance of adequately managing them before and after surgery. OBJECTIVE We aim to assess the current evidence for managing conventional synthetic and/or biologic DMARDs in the perioperative period for elective spine surgery. METHODS A systematic review of four databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included manuscripts were methodically scrutinized for quality, postoperative infections, wound healing characteristics, bone fusion rates, and clinical outcomes. RESULTS Six studies were identified describing the management of conventional synthetic and/or biologic DMARDs. There were 294 DMARD-treated patients described undergoing various spine surgeries such as craniovertebral junction fusions. Three of the studies involved exclusive continuation of DMARDs in the perioperative window; one study involved exclusive discontinuation of DMARDs in the perioperative window; and two studies involved continuation or discontinuation of DMARDs perioperatively. Of patients that continued DMARDs in the perioperative period, 13/50 patients (26.0%) had postoperative surgical site infections or wound dehiscence, 2/19 patients (10.5%) had delayed wound healing, and 32/213 patients (15.0%) had secondary revision surgeries. A fusion rate of 14/19 (73.6%) was described in only one study for patients continuing DMARDs perioperatively. CONCLUSIONS The available published data may suggest a higher risk of wound healing concerns and lower than average bone fusion, although this may be under-reported given the current state of the literature.
Collapse
Affiliation(s)
- James C Mamaril-Davis
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | - Pedro Aguilar-Salinas
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | - Mauricio J Avila
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA
| | | | - Travis M Dumont
- Department of Neurosurgery, University of Arizona, 1501 N Campbell Avenue, Room 4303, Tucson, AZ, 32207, USA.
| |
Collapse
|
12
|
Sakuraba K, Omori Y, Kai K, Terada K, Kobara N, Kamura S, Fujimura K, Bekki H, Ohta M, Miyahara HA, Fukushi JI. Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery. Arthritis Res Ther 2022; 24:79. [PMID: 35361268 PMCID: PMC8969231 DOI: 10.1186/s13075-022-02767-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study. Methods A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis. Results Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio]: lower height [0.928, p=0.007], higher ASA-PS [2.296, p=0.048], longer operation time [1.013, p=0.003], more bleeding volume [1.004, p=0.04], higher rates of vertical subluxation [2.914, p=0.015] and subaxial subluxation (SAS) [2.507, p=0.036], occipito-cervical (OC) fusion [3.438, p=0.023], and occipito-cervical/thoracic (long) fusion [8.021, p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915, p=0.005], higher ASA-PS [2.622, p=0.045] and long fusion [7.289, p=0.008] remained risk factors. High-dose prednisolone use [1.247, p=0.028], SAS [6.413, p=0.018], OC fusion [17.93, p=0.034], and long fusion [108.1, p<0.001] were associated with severe complications. Conclusions ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.
Collapse
Affiliation(s)
- Koji Sakuraba
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan. .,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Yuki Omori
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kazuhiro Kai
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kazumasa Terada
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Nobuo Kobara
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Satoshi Kamura
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kenjiro Fujimura
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hirofumi Bekki
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Masanari Ohta
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hisa-Aki Miyahara
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| |
Collapse
|
13
|
Drosos AA, Pelechas E, Georgiadis AN, Voulgari PV. A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review. Mediterr J Rheumatol 2021; 32:256-263. [PMID: 34964030 PMCID: PMC8693302 DOI: 10.31138/mjr.32.3.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) may affect any diarthrodial joint with a predilection on the peripheral skeleton in a symmetrical manner. When the axial skeleton is affected, it is the cervical spine (CS) that gets involved with potentially detrimental effects, if not treated promptly. Case: A 60-year-old female suffering from RA presented with severe neck pain and stiffness, difficulty of standing and walking with brisk tendon reflexes, Babinski sign positive, and clonus. Despite the high inflammatory markers and high titres of autoantibodies (rheumatoid factor and anticitrullinated protein antibodies), she never received proper treatment. She was using only paracetamol and non-steroidal anti-inflammatory drugs. Conventional radiography (CR) of CS showed extensive degenerative changes affecting the C3–C5 vertebral level. Magnetic Resonance Imaging of the neck showed sub-axial subluxation (SAS) and spinal cord compression at C3 level, and to a lesser extent, in other levels. A multi-level cervical laminectomy and spinal cord decompression were deployed with good results. To this end, literature review was performed until September 2020 and showed that the frequency of radiological findings varies substantially, ranging between 0,7–95% in different studies. The most common radiological feature is the atlanto-axial subluxation (AAS) followed by SAS. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR, which is an easy-to-perform technique and gives important information as a screening tool. On the other hand, RA patients need to be treated in a prompt and efficient manner in order to avoid any potentially fatal complications.
Collapse
Affiliation(s)
- Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Athanasios N Georgiadis
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| |
Collapse
|
14
|
Xu S, Meng FQ, Guo C, Liang Y, Zhu ZQ, Liu HY. Modified Hidden Blood Loss Based on Drainage in Posterior Surgery on Lumbar Stenosis Syndrome with Rheumatoid Arthritis. Orthop Surg 2021; 13:2263-2270. [PMID: 34672095 PMCID: PMC8654656 DOI: 10.1111/os.13157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Publications on hidden blood loss (HBL) after posterior lumbar interbody fusion (PLIF) for lumbar spine stenosis syndrome (LSS) have been reported, but the modified HBL (mHBL) was different from HBL obtained by classical formula and there are few studies on lumbar spine hemorrhage with rheumatoid arthritis (RA). Therefore, the aim of our study is to respectively evaluate the importance of hidden blood loss (HBL) and modified HBL (mHBL) after posterior lumbar interbody fusion (PLIF) in patients diagnosed with LSS and RA, to explore the correlation between RA activity and HBL as well as mHBL. METHODS A total of 61 patients (nine males and 52 females) diagnosed with LSS and RA who underwent PLIF were included. Data contained demographics, RA-related parameters such as duration of RA, Steinbrocker classification (used to evaluated RA activity), the disease-modifying anti-rheumatic drugs (DMARDs), osteoporosis and total knee arthroplasty; operation and hemorrhage parameters. Then HBL and mHBL were calculated by Gross formula and modified formula, respectively. Subgroup analysis on HBL and mHBL was performed based on gender, age (≤60 years and ˃60 years), different number of surgical segments (single segment, double segment, and ≥3 segments), and taking DMARDs or not. ANOVA analysis was performed on HBL and mHBL in different surgery segment number and Steinbrocker classification of RA. Independent sample t-test was used in comparison of gender and age, as well as in comparison between HBL and mHBL based on whether the patient took DMARDs or not. Furthermore, paired t-test was used to compare the volume between HBL and mHBL. RESULTS The mean age and duration of RA was 65.2 ± 9.3 years and 14.3 ± 10.7 years, respectively. There were 13 grade I cases, 34 grade II cases, and 14 grade III cases as assessed by Steinbrocker classification and the most common anti-RA drugs were DMARDs (57.4%). The mean intraoperative bleeding, drainage, and blood loss in drainage (DBL) was 453.3 ± 377.8 mL, 489.1 ± 253.8 mL, and 304.6 ± 156.3 mL, respectively. There was no difference on HBL and mHBL in gender. HBL and mHBL was larger in patients over 60 years (P = 0.040 and P = 0.023). There were differences in intraoperative blood loss, drainage, and DBL based on different number of segments but not in HBL and mHBL, or on Steinbrocker classification. DBL was lower in DMARDs group than non-drugged group (P = 0.03), while HBL and mHBL were both of no significance. The comparison of HBL and mHBL showed statistical difference (P < 0.001), suggesting that mHBL volume is larger than HBL. CONCLUSIONS Patients diagnosed as LSS with RA have amounts of HBL or mHBL after PLIF. HBL or mHBL is not associated with RA activity, which may not increase in RA patients compared with common ones. Taking DMARDs may reduce postoperative DBL. The fact that mHBL is larger than HBL provides an all-round basis for measuring factual HBL.
Collapse
Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Fan-Qi Meng
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Zhen-Qi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Hai-Ying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| |
Collapse
|
15
|
Curry BP, Ravindra VM, Boulter JH, Neal CJ, Ikeda DS. Bow hunter syndrome in rheumatoid arthritis: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21298. [PMID: 35854915 PMCID: PMC9265219 DOI: 10.3171/case21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) frequently features degeneration and instability of the cervical spine. Rarely, this degeneration manifests as symptoms of bow hunter syndrome (BHS), a dynamic cause of vertebrobasilar insufficiency. OBSERVATIONS The authors reviewed the literature for cases of RA associated with BHS and present a case of a man with erosive RA with intermittent syncopal episodes attributable to BHS as a result of severe extrinsic left atlantooccipital vertebral artery compression from RA-associated cranial settling. A 72-year-old man with RA-associated cervical spine disease who experienced gradual, progressive functional decline was referred to a neurosurgery clinic for evaluation. He also experienced intermittent syncopal events and vertiginous symptoms with position changes and head turning. Vascular imaging demonstrated severe left vertebral artery compression between the posterior arch of C1 and the occiput as a result of RA-associated cranial settling. He underwent left C1 hemilaminectomy and C1–4 posterior cervical fusion with subsequent resolution of his syncope and vertiginous symptoms. LESSONS This is an unusual case of BHS caused by cranial settling as a result of RA. RA-associated cervical spine disease may rarely present as symptoms of vascular insufficiency. Clinicians should consider the possibility, though rare, of cervical spine involvement in patients with RA experiencing symptoms consistent with vertebral basilar insufficiency.
Collapse
Affiliation(s)
- Brian P. Curry
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Vijay M. Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California; and
| | - Jason H. Boulter
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Chris J. Neal
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Daniel S. Ikeda
- Department of Surgery, U.S. Naval Hospital Okinawa, Okinawa, Japan
| |
Collapse
|
16
|
Long G, Hu Z, Jiao Z, Ping Y, Yan S, Feng Y, Xiangsheng T, Mingsheng T. A radiologic parameter that could be applied in the development of sleep apnea in rheumatoid arthritis patients undergoing occipitocervical fusion. J Orthop Sci 2021; 26:521-527. [PMID: 32620341 DOI: 10.1016/j.jos.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/23/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of sleep apnea in rheumatoid arthritis (RA) patients with occipitocervical lesions was 79%. Occipitocervical fusion (OCF) could incur sleep apnea or worsen this condition. Recent studies reported that this complication is caused by stenosis of the oropharyngeal airway accompanying a decrease in the occipitoaxial angle (O-C2a). However, there are several limitations to the application of the O-C2a, which decreases its effectiveness. Therefore, we aimed to evaluate the association between a new radiologic parameter, the CVT/NSL angle (CVT: craniocervical inclination in the second and fourth vertebrae; NSL: Nasion-Sella line), and sleep apnea in RA patients accepting OCF. METHODS A total of 35 patients who underwent OCF due to upper cervical lesions secondary to RA and had sleep apnea before surgery were analyzed. Those who have a postoperative apnea-hypopnea index (AHI) < 15 and a ΔAHI ≥50% were considered "responders"; patients were otherwise considered "non-responders." They were analyzed whether pre- and postoperative radiologic parameters and their differences in plain lateral radiographs were correlated to the parameter related to sleep apnea. RESULTS The included patients have a mean AHI of 21.9 (range, 10 to 52) before surgery. The mean postoperative CVT/NSLa, ΔCVT/NSLa, andΔO-C2a in complete responders were significantly greater compared with non-responders (p < 0.05). Both the changes in the CVT/NSLa and O-C2a were linearly correlated within patients. However, the R2 value for the CVT/NSLa was greater compared with the O-C2a (0.403 vs. 0.203). CONCLUSIONS The usefulness of the new craniovertebral angle, CVT/NSLa, as an intraoperative indicator during OCF, is more valuable in comparison with the conventional method of measuring the O-C2a. Measuring the craniovertebral angle is extremely important in the planning of surgical treatment for the development of sleep apnea in rheumatoid arthritis patients undergoing occipitocervical fusion.
Collapse
Affiliation(s)
- Gong Long
- Department of Orthopedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China
| | - Zhang Hu
- Department of Orthopedic, The 980th Hospital of Joint Logistic Support Force of PLA, China
| | - Zhang Jiao
- Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China
| | - Yi Ping
- Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China
| | - Sun Yan
- Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China
| | - Yang Feng
- Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China
| | - Tang Xiangsheng
- Chinese PLA Institute of Otolaryngology, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, 100853, China
| | - Tan Mingsheng
- Department of Orthopedic, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100853, China.
| |
Collapse
|
17
|
Beyer B, Feipel V, Dugailly PM. Biomechanics of the upper cervical spine ligaments in axial rotation and flexion-extension: Considerations into the clinical framework. J Craniovertebr Junction Spine 2020; 11:217-225. [PMID: 33100772 PMCID: PMC7546058 DOI: 10.4103/jcvjs.jcvjs_78_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Context: The motion of the upper cervical spine (UCS) has a great interest for analyzing the biomechanical features of this joint complex, especially in case of instability. Although investigators have analyzed numerous kinematics and musculoskeletal characteristics, there are still little data available regarding several suboccipital ligaments such as occipito-atlantal, atlantoaxial, and cruciform ligaments. Objective: The aim of this study is to quantify the length and moment arm magnitudes of suboccipital ligaments and to integrate data into specific 3D-model, including musculoskeletal and motion representation. Materials and Methods: Based on a recent method, suboccipital ligaments were identified using UCS anatomical modeling. Biomechanical characteristics of these anatomical structures were assessed for sagittal and transversal displacements regarding length and moment arm alterations. Results: Outcomes data indicated length alterations >25% for occipito-atlantal, atlanto-axial and apical ligaments. The length alteration of unique ligaments was negligible. Length variation was dependent on the motion direction considered. Regarding moment arm, larger magnitudes were observed for posterior ligaments, and consistent alteration was depicted for these structures. Conclusion: These outcomes supply relevant biomechanical characteristics of the UCS ligaments in flexion-extension and axial rotation by quantifying length and moment arm magnitude. Moreover, 3D anatomical modeling and motion representation can help in the process of understanding of musculoskeletal behaviors of the craniovertebral junction.
Collapse
Affiliation(s)
- Benoît Beyer
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Anatomy, Faculty of Medicine, Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Anatomy, Faculty of Medicine, Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre-Michel Dugailly
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Osteopathy, CESPU - Escola Superior de Saùde do Vale do Ave, Famalicão, Portugal
| |
Collapse
|
18
|
Shlobin NA, Dahdaleh NS. Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev 2020; 44:1957-1965. [PMID: 33037539 DOI: 10.1007/s10143-020-01412-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.
Collapse
Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| |
Collapse
|
19
|
Macías-García D, Jurado Serrano J, Parada Blazquez M, Moniche F. Acute lower limb paresis in a patient with rheumatoid arthritis: emergency neuroimaging findings. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
20
|
Macías-García D, Jurado Serrano J, Parada Blazquez M, Moniche F. Paresia aguda de miembro inferior en paciente con artritis reumatoide: hallazgos en la neuroimagen de urgencia. Neurologia 2020; 35:593-595. [DOI: 10.1016/j.nrl.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/10/2019] [Accepted: 05/04/2019] [Indexed: 11/29/2022] Open
|
21
|
Hong JT, Kim IS, Lee HJ, Park JH, Hur JW, Lee JB, Lee JJ, Lee SH. Evaluation and Surgical Planning for Craniovertebral Junction Deformity. Neurospine 2020; 17:554-567. [PMID: 33022160 PMCID: PMC7538356 DOI: 10.14245/ns.2040510.255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022] Open
Abstract
Craniovertebral junction (CVJ) deformity is a challenging pathology that can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. Surgical management of CVJ deformity is complex for anatomical reasons; given the discreet relationships involved in the surrounding neurovascular structures and intricate biochemical issues, access to this region is relatively difficult. Evaluation of the reducibility, CVJ alignment, and direction of the mechanical compression may determine surgical strategy. If CVJ deformity is reducible, posterior in situ fixation may be a viable solution. If the deformity is rigid and the C1–2 facet is fixed, osteotomy may be necessary to make the C1–2 facet joint reducible. C1–2 facet release with vertical reduction technique could be useful, especially when the C1–2 facet joint is the primary pathology of CVJ kyphotic deformity or basilar invagination. The indications for transoral surgery are becoming as narrow as a treatment for CVJ deformity. In this article, we will discuss CVJ alignment and various strategies for the management of CVJ deformity and possible ways to prevent complications and improve surgical outcomes.
Collapse
Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Hyuk Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Jeong Woo Hur
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University, Cheongju, Korea
| | - Jeong Jae Lee
- Department of Neurosurgery, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Hyo Lee
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
22
|
Impact of Chronic DMARD Therapy in Patients With Rheumatoid Arthritis Undergoing Surgery of the Craniovertebral Junction: A Multi-center Retrospective Study. Spine (Phila Pa 1976) 2020; 45:930-936. [PMID: 32039944 DOI: 10.1097/brs.0000000000003402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A multi-centered retrospective review from five institutions. OBJECTIVE The aim of this study was to determine whether continuing or withholding disease-modifying antirheumatoid drugs (DMARDs) in the perioperative period affect outcomes in rheumatoid arthritis (RA) patients undergoing arthrodesis at the craniovertebral junction SUMMARY OF BACKGROUND DATA.: RA is a chronic systemic inflammatory disease that affects the cervical spine and is treated with DMARDs. Some advocate withholding DMARDs in the perioperative period due to concern for the cytotoxic effects of these medications. However, the impact of DMARDs in the perioperative period is not well understood. METHODS A multicenter retrospective study from five affiliated institutions was performed. Adult patients with RA on chronic DMARDs undergoing posterior arthrodesis of the craniovertebral junction (occipital-cervical or atlanto-axial arthrodesis) were identified. Patients were stratified based on whether DMARD therapy was continued (C group) or discontinued (DC group) in the perioperative period. The primary outcome was the need for reoperation and reason for reoperation. RESULTS Thirty-nine patients met inclusion criteria, 19 in C group and 20 in DC group. Average follow-up time was 42 months. Four patients (three in DC group and one in C group) required reoperation. Two patients from the DC group required readmission secondary to RA flare-up. CONCLUSION Our cohort of RA patients who underwent occipital-cervical and C1/C2 posterior arthrodesis showed no significant differences in surgical complications when DMARD therapy was continued or discontinued in the perioperative period. The decision to continue or discontinue DMARD therapy in the perioperative period is at the discretion of the treating physician, but we encourage physicians to counsel patients regarding this theoretical risk and their tolerance of the medications as well as the risk of RA flare-up. Factors such as overall health, disease burden, nutrition, bone quality, smoking status, and other comorbid conditions are likely to have a larger influence on perioperative complications. LEVEL OF EVIDENCE 3.
Collapse
|
23
|
Radiological Findings of the Cervical Spine in Rheumatoid Arthritis: What a Rheumatologist Should Know. Curr Rheumatol Rep 2020; 22:19. [DOI: 10.1007/s11926-020-00894-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Shi J, Ermann J, Weissman BN, Smith SE, Mandell JC. Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol 2019; 48:1511-1523. [PMID: 30868232 DOI: 10.1007/s00256-019-03187-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
Collapse
Affiliation(s)
- Junzi Shi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Joerg Ermann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Barbara N Weissman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| |
Collapse
|
25
|
Blood Loss of Posterior Lumbar Interbody Fusion on Lumbar Stenosis in Patients With Rheumatoid Arthritis: A Case-Control Study. Spine (Phila Pa 1976) 2019; 44:E1045-E1052. [PMID: 30985568 DOI: 10.1097/brs.0000000000003037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case-control study. OBJECTIVE To compare intraoperative bleeding, drainage, and hidden blood loss (HBL) of posterior lumbar interbody fusion (PLIF) on lumbar spinal stenosis (LSS) in patients with rheumatoid arthritis (RA) and non-RA and identify the risk factors of HBL with RA. SUMMARY OF BACKGROUND DATA Exploration on PLIF on LSS and HBL has been reported before while the comparison on total blood loss (TBL), especially HBL of PLIF or PLF on LSS between patients with RA and without RA has not been studied. METHODS Sixty-one patients diagnosed LSS with RA (RA group) and 87 matched patients without RA (NRA group) were enrolled and demographic characteristics, RA-related parameters, operation and blood loss information were extracted. Intraoperative blood loss, drainage, and HBL were primary outcomes and secondary measures included operation time, hematocrit (Hct) and hemoglobin (Hb), the number of anemia and blood transfusion. RESULTS There was no statistical difference in total blood loss (TBL), intraoperative blood loss, and postoperative drainage while HBL and the proportion of HBL in TBL were lower in NRA group (P < 0.001 and P = 0.012, respectively). Stratified analysis based on the number of surgical levels suggested HBL and the proportion of HBL in NRA group was superior in long-segment surgery (>2 segments). The secondary outcomes showed the change of Hct was lower in NRA group (P = 0.021) but not the reduction of Hb. In addition, there was no significant difference in neoformative and grade-aggravated anemia, as well as the number of allogeneic blood transfusion and operation time showed Steinbroker classification, disease-modifying anti-rheumatic drugs (DMARDs), hange of Hb and allogeneic blood transfusion were risk factors for HBL with RA. CONCLUSION There was no difference in TBL, intraoperative bleeding, and operation time, but HBL were higher in RA patients particularly in long-segmental operation. Steinbroker classification, DMARDs, the change of Hb, and allogeneic blood transfusion were independent risk factors for HBL in RA patients. LEVEL OF EVIDENCE 3.
Collapse
|
26
|
Tominaga H, MacDowall A, Olerud C. Surgical treatment of the severely damaged atlantoaxial joint with C1-C2 facet spacers: Three case reports. Medicine (Baltimore) 2019; 98:e15827. [PMID: 31145323 PMCID: PMC6708912 DOI: 10.1097/md.0000000000015827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Atlantoaxial subluxation (AAS), caused by congenital factors, inflammation such as rheumatoid arthritis, infection, neoplasia, or trauma, is rare and severely erodes and subluxates atlantoaxial (AA) joints. For these patients, surgical reduction, and stabilization are difficult. Surgery, including anterior transoral decompression and posterior fixation, anterior endonasal decompression and fixation, and posterior decompression with AA or occipitocervical fixation, is often the only treatment available. However, there have only been 2 reports of C1-C2 facet spacer use in treating AAS. Here, we report the case histories of 3 patients with severely damaged and subluxated AA joints and symptomatic basilar invagination (BI), malalignment, or C2 root compression. PATIENT CONCERNS The cases included 2 women with rheumatoid arthritis and 1 man with spondyloarthropathy secondary to ulcerative colitis. DIAGNOSIS Radiographic imaging revealed severely damaged and subluxated AA joints. Their symptoms included worsening pain in the neck or occiput with or without myelopathy and neuralgia. INTERVENTIONS After realignment with C1-C2 spacers and posterior C1-C2 screw fixation, the patient symptoms were resolved. OUTCOMES Of note, 2 of the 3 patients were healed without complications. One patient who underwent secondary revision surgery because of rod breakage and obvious nonunion at C0-C2 was determined to be healed at 1-year follow-up after the revision surgery. LESSONS We confirmed that C1-C2 facet spacers both reduced BI and occipitocervical coronal malalignment as well as releasing C2 root compression. Therefore, surgical restoration and fixation should be a required treatment in this very rare group of patients.
Collapse
Affiliation(s)
- Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
27
|
Ferrante A, Ciccia F, Giammalva GR, Iacopino DG, Visocchi M, Macaluso F, Maugeri R. The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art. ACTA NEUROCHIRURGICA SUPPLEMENT 2019; 125:79-86. [DOI: 10.1007/978-3-319-62515-7_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
28
|
Hagege B, Tubach F, Alfaiate T, Forien M, Dieudé P, Ottaviani S. Increased rate of lumbar spondylolisthesis in rheumatoid arthritis: A case-control study. Eur J Clin Invest 2018; 48:e12991. [PMID: 29956820 DOI: 10.1111/eci.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of lumbar spondylolisthesis (SPL) in patients suffering from low back pain (LBP) with or without rheumatoid arthritis (RA) and to identify potential factors associated with SPL in patients with RA. METHODS We performed a case-control study. Cases and control patients had chronic LBP (more than 4 weeks). Patient with RA fulfilled the 2010 ACR/EULAR criteria. The main outcome was the presence of lumbar SPL on lumbar X-ray. The prevalence of SPL between RA and control patients was compared using chi-squared test. Potential factors associated with SPL in patients with RA were investigated by univariate and multivariate analysis, estimating odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS A total of 67 cases and 83 controls were included. Median [interquartile range] age of patients with RA was 60.0 years [51.0-72.0]; 80.6% were females; and 92.5% and 83.6% were positive for anti-citrullinated protein antibodies (ACPAs) or rheumatoid factor, respectively. Mean RA disease duration was 11.2 ± 8.7 years. SPL was more frequent in patients with RA than controls (41.8% versus 18.1%, P = 0.001). Adjusted to gender, RA was associated with increased prevalence of SPL (OR 3.15 [95% CI 1.48-6.70], P = 0.003). Among patients with RA, SPL was mainly Grade 1 (85.7%). Multivariate analysis revealed SPL is associated with increased age in patients with RA (OR 1.06 [1.02-1.11], P = 0.004). CONCLUSION In a population of patients with chronic LBP, the prevalence of lumbar SPL was higher with than without RA. SPL might be explained by synovitis of lumbar facet joints.
Collapse
Affiliation(s)
- Benjamin Hagege
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Florence Tubach
- AP-HP, Département de Biostatistiques, Santé Publique et Informatique Médicale, Hôpital Pitié-Salpêtrière, Paris, France.,CIC-EC 1425, ECEVE UMR 1123, INSERM, Paris, France
| | - Toni Alfaiate
- AP-HP, Département d'Epidémiologie, Biostatistique et Recherche Clinique, Hôpital Bichat, Paris, France
| | - Marine Forien
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Philippe Dieudé
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
29
|
Kim SH, Kim H, Kim S, Paek S, Koh JH, Lee J, Cho YW, Park SH. Sleep Quality Independently Affects Health-related Quality of Life and Cognitive Function in Korean Female Patients with Rheumatoid Arthritis: a Case-control Study. J Korean Med Sci 2018; 33:e216. [PMID: 30140189 PMCID: PMC6105772 DOI: 10.3346/jkms.2018.33.e216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to address sleep quality in patients with rheumatoid arthritis (RA) and to determine how it affects health-related quality of life (HRQoL) and cognitive function. METHODS One hundred and twenty-three patients with RA and 76 healthy controls were enrolled in this study. Sleep quality was assessed using the Korean version of the Pittsburgh Sleep Quality Index (PSQI). Cognitive function and HRQoL was evaluated by a Korean-Montreal Cognitive Assessment (MoCA-K) and 36-item Short-Form Health Survey (SF-36), respectively. Other clinical, demographic, and laboratory data were obtained from retrospective medical chart review. RESULTS More patients in the RA group reported poor sleep quality (PSQI > 5) than in the control group (61% [75/123] vs. 39.5% [30/76]; P = 0.003). Total PSQI was also significantly higher in the RA group (median [interquartile range], 7 [5-11] vs. 5 [3-6.75]; P = 0.001). Total PSQI score negatively correlated with MoCA-K score (Spearman's rho (r) = -0.223; P = 0.003) with a physical component summary (PCS) of SF-36 (r = -0.221; P = 0.003) and a mental component summary (MCS) of SF-36 (r = -0.341; P < 0.001), which means that poor sleep quality was associated with poor cognitive function and low HRQoL. CONCLUSION The findings of this study suggest that poor sleep quality is an independent risk factor for low HRQoL and cognitive dysfunction. Efforts to improve the sleep quality of RA patients seem to be an important aspect of integrative treatment for RA.
Collapse
Affiliation(s)
- Seo Hwa Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Haneul Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seungju Kim
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - SeungIn Paek
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong-Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
30
|
Sardi JP, Iwanaga J, Voin V, Schmidt C, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. The Alar Ligaments: A Cadaveric and Radiologic Comparison Study. World Neurosurg 2018; 110:517-520. [PMID: 29433175 DOI: 10.1016/j.wneu.2017.07.080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A precise anatomical description of the alar ligaments is important to better understand their biomechanical and pathologic implications. Although there are several studies regarding their anatomy, the literature is inconsistent. To our knowledge, there are no reports that compare cadaveric morphologic findings with computed tomography (CT) images of the alar ligaments. METHODS Eight sides from 4 fresh-frozen cadaveric specimens were used in this study. After routine dissection of the craniocervical junction, the alar ligaments were exposed. We carried out measurements of the alar ligaments, their position within the craniovertebral junction, and their relation to the dens and adjacent structures. Fine-cut CT of the specimens was performed, and the measurements were later compared with the original cadaveric dissections. RESULTS Alar ligaments were attached to the upper half of the lateral surface of the dens and ran laterally to its insertion just medial to the occipital condyle. The ligaments were found to have an ovoid cross-sectional area with a nearly horizontal caudocranial trajectory and comparable diameters in both anteroposterior and superoinferior directions between the CT and cadaveric measurements. CONCLUSIONS There were small but not statistically significant differences in the measurements between the cadaver specimens and the CT images. There was however, a strong correlation between the proximal and distal insertions, as well as the orientation of the fibers, that suggests CT images can be an appropriate approach to the study of the anatomical and 3-dimensional features of the alar ligaments.
Collapse
Affiliation(s)
- Juan P Sardi
- Departamento Neurociencias, Hospital Universitario San Ignacio, Unidad Neurocirugía, Bogotá, Colombia.
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Fukuoka, Japan; Dental and Oral Medical Center, Kurume University School of Medicine, Fukuoka, Japan
| | - Vlad Voin
- Seattle Science Foundation, Seattle, Washington, USA
| | | | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| |
Collapse
|
31
|
Bodakçi E, Üsküdar Cansu D, Ertürk A, Çalişir C, Korkmaz C. Can neck pain be an initial symptom of rheumatoid arthritis? A case report and literature review. Rheumatol Int 2018; 38:925-931. [PMID: 29589114 DOI: 10.1007/s00296-018-4019-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
Although rheumatoid arthritis (RA) is most commonly associated with peripheral joints, cervical spine involvement can be seen in almost 80% of patients in the presence of long-term disease, joint erosion, and risk factors such as male sex and rheumatoid factor positivity. It is very rare to have cervical involvement in the initial period of RA. If a patient has isolated cervical spine involvement without peripheral arthritis, it is highly likely that inappropriate investigations and delayed treatment may occur. Any damage that occurs in cervical spine may cause symptoms varying from slight instability to atlantoaxial subluxation, spinal cord and brain stem compression and even death. Therefore, physician should be aware that there may be isolated cervical involvement, albeit rare, in patients with RA. In this report, we presented a case of RA presenting with cervical spine involvement without peripheral arthritis to underline the importance of this kind of involvement in clinical practice. We also briefly reviewed other cases similar to ours in light of literature.
Collapse
Affiliation(s)
- Erdal Bodakçi
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey.
| | - Adem Ertürk
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Cüneyt Çalişir
- Department of Radiology, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| |
Collapse
|
32
|
Lisitskiy IY, Kiselev AM, Kiselev SE. [Rheumatoid atlanto-axial dislocation: a surgical approach]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2018. [PMID: 29543214 DOI: 10.17116/neiro201882141-47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pathological processes in the craniovertebral region (CVR) are usually accompanied by dislocation complications leading to gross neurological disorders. One of the diseases that affect the CVR and lead to atlanto-axial dislocation (AAD) is rheumatoid arthritis. Errors in the diagnosis of rheumatoid disease and in the choice of a treatment approach may cause adverse outcomes. OBJECTIVE To define the approach for surgical treatment of AAD associated with rheumatoid disease of the CVR, with allowance for the rigidity of deformity. MATERIAL AND METHODS Five patients with rheumatoid AAD, 4 females and 1 male, aged 54 to 73 years underwent surgery. All dislocations were anterior ones. Three patients had mobile pannus-associated dislocation. In 2 cases, AAD was rigid and combined with odontoid invagination into the foramen magnum (FM). RESULTS In all mobile AAD cases, decompression of the brainstem and restoration of the normal anatomical relationships in the CVR were achieved by dislocation correction and atlanto-axial fusion performed from the posterior approach, avoiding transoral interventions. In this case, spontaneous resorption of the pannus occurred within several months after surgery. In the postoperative period, all patients achieved significant regression of pain and neurological disorders. Complications in the form of wound infection developed in 1 case. CONCLUSION A decision algorithm for choosing a surgical treatment option was based on the degree of deformity stability. Mobile AADs serve as an indication for indirect decompression using instrumental correction of dislocation and atlantoaxial fixation from the posterior approach. In the case of fixed AAD, posterior fixation is complemented by anterior decompression via the transoral approach.
Collapse
Affiliation(s)
- I Yu Lisitskiy
- Vladimirsky Moscow Regional Research Clinical Institute. Shchepkina Str., 61/2, Moscow, Russia,129110
| | - A M Kiselev
- Vladimirsky Moscow Regional Research Clinical Institute. Shchepkina Str., 61/2, Moscow, Russia,129110
| | - S E Kiselev
- Dolgoprudny Central City Hospital, Pavlova Str., 2, Dolgoprudny, Moscow Region, Russia, 141704
| |
Collapse
|
33
|
Endoscopic Endonasal Odontoidectomy with Anterior C1 Arch Preservation in Rheumatoid Arthritis: Long-Term Follow-Up and Further Technical Improvement by Anterior Endoscopic C1-C2 Screw Fixation and Fusion. World Neurosurg 2017; 107:820-829. [DOI: 10.1016/j.wneu.2017.08.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/06/2017] [Accepted: 08/10/2017] [Indexed: 12/19/2022]
|
34
|
[The rheumatic cervical spine]. Z Rheumatol 2017; 76:838-847. [PMID: 28986633 DOI: 10.1007/s00393-017-0388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The cervical spine is one of the main sites of manifestation in rheumatoid arthritis outside of the extremities. It can have a decisive influence on disease course via the occurrence of mechanical instabilities as well as neurologic symptoms. Both adequate diagnosis and the corresponding surgical treatment represent a challenge for the involved physicians. MATERIALS AND METHODS This review presents relevant diagnostic strategies and possibilities for surgical intervention which aim to avoid potentially fatal neurologic symptoms. Basic literature and expert opinions are also discussed. RESULTS AND CONCLUSION Through target-oriented surgical management, as well as tight clinical and radiologic monitoring during conservative and surgical therapy, potentially fatal disease courses can be avoided.
Collapse
|
35
|
Abstract
Neurologic manifestations of rheumatoid arthritis (RA) range in severity from mild paresthesias in the hand from carpal tunnel syndrome to sudden death due to impingement of the medulla by an eroded, vertically subluxed dens. Most neurologic complications are a consequence of articular inflammation and damage that leads to compression of adjacent structures of the central or peripheral nervous systems. Rare but serious extra-articular manifestations include inflammation of the meninges and ischemic neuropathies due to necrotizing arteritis of the vasa vasorum. Medical therapy with synthetic disease-modifying antirheumatic drugs and biological agents has diminished the incidence of serious neurologic manifestations in RA.
Collapse
Affiliation(s)
- Kimberly DeQuattro
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John B Imboden
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
36
|
Cervical spine instability in the course of rheumatoid arthritis - imaging methods. Reumatologia 2017; 55:201-207. [PMID: 29056776 PMCID: PMC5647537 DOI: 10.5114/reum.2017.69782] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022] Open
Abstract
Cervical spine is affected in more than a half of patients with rheumatoid arthritis (RA). Depending on the degree of damage to the individual joints and ligaments RA-related cervical spine instability takes the form of atlanto-axial subluxation, subaxial subluxation or cranial settling. In the advanced cases spinal stenosis can occur as well as spinal cord injuries with typical neurological symptoms. The identification of patients with cervical spine instability before the occurrence of neurological complications still constitutes a diagnostic challenge. The article presents the methods of cervical spine imaging with the use of plain radiographs, magnetic resonance imaging (MRI) and computed tomography (CT). We discuss the advantages and disadvantages associated with each method and the possibility of its application in the diagnosis of cervical spine instability in RA. The knowledge of the above mentioned issues is indispensable to select an appropriate time for surgical intervention.
Collapse
|
37
|
Iwanaga J, Sardi J, Voin V, Chapman JR, Oskouian RJ, Tubbs RS. Anatomy of Alar Ligament Part I: Morphometrics and Variants. World Neurosurg 2017; 107:1001-1006. [PMID: 28826867 DOI: 10.1016/j.wneu.2017.07.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/26/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The alar ligaments are among the primary ligamentous structures contributing to craniovertebral stability. The purpose of this study is to clarify the morphology of the alar ligament using fresh cadaveric specimens. METHODS Twenty-two fresh, frozen cadaveric alar ligaments were used in this study. The occiput, C1, and C2 were removed en bloc from each specimen, and various measurements and observations including variations were documented. RESULTS The angle formed by both alar ligaments was measured in a neutral position (149 ± 24.19 degrees), as well as during forced flexion (134.18 ± 27.08 degrees) and extension (163.81 ± 24.54 degrees). CONCLUSIONS The current cadaveric evaluation offers an interesting window into better understanding the anatomy of the alar ligaments.
Collapse
Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan; Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Juan Sardi
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Vlad Voin
- Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Rod J Oskouian
- Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| |
Collapse
|
38
|
Koziarz A, Aref M, Vinh B, Mensinkai A, Almenawer SA, Reddy K. Sublaminar wire migration into the medulla oblongata: a case report. JOURNAL OF SPINE SURGERY 2017; 3:267-271. [PMID: 28744511 DOI: 10.21037/jss.2017.05.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atlantoaxial procedures have been developed in an effort to ensure solid C1-C2 fusion. However, techniques that involve sublaminar wiring have the potential for neural structure injury. We present the management of a patient who previously underwent Gallie fusion 10 years ago and is presenting with a dislodged titanium wire that has migrated into the medulla oblongata. A 52-year-old female patient known with rheumatoid arthritis presented with truncal ataxia and food regurgitation 10 years after undergoing a C1-C2 Gallie fusion. A computerized tomography (CT) scan revealed that a wire from her Gallie fusion procedure migrated into the medulla oblongata. The patient underwent foramen magnum decompression with C1 bilateral laminectomy, instrumentation, and removal of a migrated wire. Six months later, a CT scan showed that all occipital screws were pulled out. In the revision surgery, new occipital screws were placed with a resultant significant improvement in patient's gait postoperatively. Wire migration as a differential diagnosis should be considered in patients presenting with neurological dysfunction who underwent surgical treatment with sublaminar wire fusion techniques.
Collapse
Affiliation(s)
- Alex Koziarz
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Mohammed Aref
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Brian Vinh
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Arun Mensinkai
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Saleh A Almenawer
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- 1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
39
|
Zhu S, Xu W, Luo Y, Zhao Y, Liu Y. Cervical spine involvement risk factors in rheumatoid arthritis: a meta-analysis. Int J Rheum Dis 2017; 20:541-549. [PMID: 28524646 DOI: 10.1111/1756-185x.13096] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuai Zhu
- Department of Rheumatology and Immunology; West China Hospital; Sichuan University; Sichuan China
| | - Wangdong Xu
- Department of Rheumatology and Immunology; West China Hospital; Sichuan University; Sichuan China
| | - Yubin Luo
- Department of Rheumatology and Immunology; West China Hospital; Sichuan University; Sichuan China
| | - Yi Zhao
- Department of Rheumatology and Immunology; West China Hospital; Sichuan University; Sichuan China
| | - Yi Liu
- Department of Rheumatology and Immunology; West China Hospital; Sichuan University; Sichuan China
| |
Collapse
|
40
|
The Effects of Clinical Factors and Retro-Odontoid Soft Tissue Thickness on Atlantoaxial Instability in Patients with Rheumatoid Arthritis. World Neurosurg 2017; 103:364-370. [PMID: 28419881 DOI: 10.1016/j.wneu.2017.04.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disease that often occurs in the atlantoaxial segment of the cervical spine and results in instability that can cause severe pain and neurologic symptoms. Thickening of soft tissue posterior to the odontoid process of the atlantoaxial segment is referred to as retro-odontoid soft tissue (ROST) thickness or pseudotumor. The mechanism of ROST thickness is still unknown. METHODS Among patients diagnosed with RA, those with cervical radiographs and magnetic resonance imaging records were selected for investigation of their clinical symptoms, laboratory findings, radiologic evaluation, and RA medication history. RESULTS A total of 199 patients were selected and divided into lower and upper median groups according to the ROST thickness value. In patients with RA, the median ROST thickness value was 2.3 mm (interquartile range, 1.4-3.4). The median value of the anterior atlanto-dens interval (ADI) was 2.4 mm, with a significant difference being observed between the lower and upper median ROST thickness groups (P = 0.001). Multivariable linear regression analysis revealed a correlation between Steinbrocker stage and the positivity of rheumatoid factor. For each unit increase in the Steinbrocker stage, the ROST thickness increased by 0.35 mm (β, -0.349; 95% confidence interval -0.643 to -0.055; P = 0.020). For every 1-mm increase in the ADI, ROST thickness decreased by 0.16 mm (β, -0.163; 95% confidence interval -0.264 to -0.062; P = 0.002). CONCLUSIONS This study showed a statistical correlation between ROST thickness and ADI related to biomechanical changes in the dynamic atlantoaxial segment, thereby suggesting the value of a prospective study.
Collapse
|
41
|
Lee JY, Im SB, Jeong JH. Use of a C1-C2 Facet Spacer to Treat Atlantoaxial Instability and Basilar Invagination Associated with Rheumatoid Arthritis. World Neurosurg 2016; 98:874.e13-874.e16. [PMID: 27916724 DOI: 10.1016/j.wneu.2016.11.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that often affects the craniovertebral junction. RA is associated with atlantoaxial instability and basilar invagination; the detailed presentations vary. Surgical treatment of atlantoaxial instability and basilar invagination caused by RA is challenging due to anatomic complexity and poor bone quality. The prevailing procedure is posterior occipitocervical fixation after transoral decompression or posterior decompression followed by occipitocervical fixation. However, these surgical modalities inevitably severely limit neck motion and cause dysesthesia of the C2 dermatome. CASE DESCRIPTION We report our surgical experience with a C1-C2 facet spacer, specifically the usual cervical cage containing an autologous bone chip combined with a C1 lateral mass screw and a C2 pedicle without resection of C2 roots. The facet space was maintained on the 3-year follow-up radiograph. CONCLUSIONS This method effectively reduces BI and allows AAI fixation without significantly compromising neck motion or causing C2 dermatome dysesthesia.
Collapse
Affiliation(s)
- Jin-Young Lee
- Department of Neurosurgery, School of Medicine, Soonchunhyang University Hospital, Bucheon-si, Gyeonggi-do, South Korea
| | - Soo-Bin Im
- Department of Neurosurgery, School of Medicine, Soonchunhyang University Hospital, Bucheon-si, Gyeonggi-do, South Korea.
| | - Je-Hoon Jeong
- Department of Neurosurgery, School of Medicine, Soonchunhyang University Hospital, Bucheon-si, Gyeonggi-do, South Korea
| |
Collapse
|
42
|
Cunningham S. Upper cervical instability associated with rheumatoid arthritis: a case report. J Man Manip Ther 2016; 24:151-7. [PMID: 27559285 DOI: 10.1179/2042618614y.0000000096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Rheumatoid arthritis (RA) affects between 1 and 2 million individuals in the United States. Atlantoaxial instability (AAI) has been shown to have 40-85% prevalence among individuals with RA. Despite the high incidence of craniovertebral involvement, overt symptoms of instability are rare. The high risk of AAI and limited symptomology should increase therapist suspicion of potential contraindications and precautions to initiation of therapy for the cervical spine without prior diagnostic imaging. The purpose of this case study is to describe the historical, clinical, and diagnostic imaging complexity of AAI associated with RA, and to illustrate the use of these factors in the clinical reasoning within a patient case.
Collapse
Affiliation(s)
- Shala Cunningham
- University of Evansville, IN, USA; Ola Grimsby Institute, UT, USA
| |
Collapse
|
43
|
Joaquim AF, Ghizoni E, Tedeschi H, Appenzeller S, Riew KD. Radiological evaluation of cervical spine involvement in rheumatoid arthritis. Neurosurg Focus 2015; 38:E4. [PMID: 25828498 DOI: 10.3171/2015.1.focus14664] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cervical spine involvement commonly occurs in patients with rheumatoid arthritis (RA), especially those with inadequate treatment or severe disease forms. The most common site affected by RA is the atlantoaxial joint, potentially resulting in atlantoaxial instability, with cervical pain and neurological deficits. The second most common site of involvement is the subaxial cervical spine, often with subluxation, resulting in nerve root or spinal cord compression. In this paper, the authors review the most commonly used plain radiographic criteria to diagnose cervical instabilities seen with RA. Finally, we discuss the advantages and disadvantages of cervical CT and MRI in the setting of cervical involvement in RA.
Collapse
|
44
|
The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions. Neurol Res Int 2015; 2015:794829. [PMID: 26770824 PMCID: PMC4681798 DOI: 10.1155/2015/794829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/07/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023] Open
Abstract
The craniocervical junction (CCJ) is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis and progression of neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, MS, and ALS, as well as many other neurological conditions including hydrocephalus, idiopathic intracranial hypertension, migraines, seizures, silent-strokes, affective disorders, schizophrenia, and psychosis. The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative and neurological conditions.
Collapse
|
45
|
Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery. Int J Rheumatol 2015; 2015:252456. [PMID: 26351458 PMCID: PMC4553335 DOI: 10.1155/2015/252456] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting a significant percentage of the population. The cervical spine is often affected in this disease and can present in the form of atlantoaxial instability (AAI), cranial settling (CS), or subaxial subluxation (SAS). Patients may present with symptoms and disability secondary to these entities but may also be neurologically intact. Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial. The aim of this paper is to describe the pathology, pathophysiology, clinical manifestations, and diagnostic evaluation of rheumatoid arthritis in the cervical spine in order to provide a better understanding of the indications and options for surgery. Both the medical and surgical treatment options for RA have improved, so has the prognosis of the cervical spine disease. With the advent of disease modifying antirheumatic drugs (DMARDs), fewer patients are presenting with cervical spine manifestations of RA; however, those that do, now have improved surgical techniques available to them. We hope that, by reading this paper, the clinician is able to better evaluate patients with RA in the cervical spine and determine in which patients surgery is indicated.
Collapse
|
46
|
Joaquim AF, Appenzeller S. Neuropsychiatric manifestations in rheumatoid arthritis. Autoimmun Rev 2015; 14:1116-22. [PMID: 26238502 DOI: 10.1016/j.autrev.2015.07.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 02/06/2023]
Abstract
Rheumatoid arthritis (RA) is a chronic disease characterized by persistent synovitis, systemic inflammation, and the presence of autoantibodies. Neuropsychiatric manifestations are quite common in RA, including depression, cognitive dysfunction, behavior changes, spinal cord compression and peripheral nerve involvement. Potential causes include systemic inflammatory process, neural compression due to bone and joint destruction, side effects of medications and copying difficulties due to the chronicity of the disease. A high level of suspicious is required for an adequate diagnosis and treatment. In this review, we will discuss topographically the main neuropsychiatric manifestations described in RA patients, in an attempt to help in the management of these complex and multifaceted disease.
Collapse
Affiliation(s)
- Andrei F Joaquim
- Department of Neurology, State University of Campinas (UNICAMP), 13083-970 Campinas SP, Brazil.
| | - Simone Appenzeller
- Department of Medicine, State University of Campinas (UNICAMP), 13083-970 Campinas SP, Brazil
| |
Collapse
|
47
|
Craniocervical junction involvement in ankylosing spondylitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2986-90. [DOI: 10.1007/s00586-015-3994-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/03/2015] [Accepted: 05/03/2015] [Indexed: 11/26/2022]
|
48
|
Joaquim AF, Appenzeller S. Cervical spine involvement in rheumatoid arthritis — A systematic review. Autoimmun Rev 2014; 13:1195-202. [PMID: 25151973 DOI: 10.1016/j.autrev.2014.08.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/13/2014] [Indexed: 10/24/2022]
|
49
|
Atlanto-axial erosion as the presenting manifestation of systemic tuberculosis: a tricky diagnosis in western countries. Acta Neurol Belg 2014; 114:321-3. [PMID: 24249384 DOI: 10.1007/s13760-013-0261-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
|
50
|
Pan J, Huang D, Hao D, Zhao Y, He B, Wu Q, Li H, Ge C. Occipitocervical fusion: fix to C2 or C3? Clin Neurol Neurosurg 2014; 127:134-9. [PMID: 25459260 DOI: 10.1016/j.clineuro.2014.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/14/2014] [Accepted: 10/16/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to explore the differences in clinical outcome between short-segment fixation (SSF; occiput-C2) and multi-segment fixation (MSF; occiput-C2, 3). METHODS From January 2008 to January 2012, patients who underwent surgery for instability at the occipitocervical junction were included in the study. Two different groups of surgeons using two different management options completed the surgeries. One group performed SSF, whereas the other group performed MSF. A total of 53 patients met the criteria (33 SSF, 20 MSF). Mean follow-up was 33.9 months (range, 12-62 months). Fusion was demonstrated by plain radiographs and computed tomography imaging. Neurological status, pillow neck pain, operative time, blood loss during operation, and perioperative complications were compared between the SSF and MSF groups. RESULTS The fusion rate was 97% in the SSF group and 100% in MSF the group. There was no statistically significant difference in the fusion rate between the two groups (P>0.05). One patient (3%) in the SSF group and two patients (10%) in the MSF group experienced perioperative complications. Of the 25 patients who had neurological symptoms, 22 (88%) showed improvement after the operation in the SSF group and 14 (87.5%) of 16 showed improvement in MSF group. In addition, patients who suffered from pillow neck pain achieved varying degrees of improvement after the operation. CONCLUSION SSF may be the better choice for treating occipitocervical instability when no subaxial instability is present. Overall, modern instrumentation can provide the stability needed for successful clinical fusion.
Collapse
Affiliation(s)
- Junwei Pan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| | - Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
| | - Yaling Zhao
- Department of Public Health, Xi'an Jiaotong University College of Medicine, Shaanxi 710061, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| | - Qining Wu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| | - Hui Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| | - Chaoyuan Ge
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China
| |
Collapse
|