Surgical Treatment of Rheumatoid Arthritis in Cervical Spine

Yang Ruifeng; Tan Junming

Abstract：Objective To summarize the clinical experience of the surgical treatment for rheumatoid arthritis (RA)of cervical spine.Methods Sixteen patients who underwent surgical treatment for cervical spine of rheumatoid arthritis between June 2012 and June 2015 were enrolled in this retrospective study.All patients were cervical vertebral instability by imaging findings into AAS,VS,SAS.Including 9 cases of reducible atlantoaxial subluxation patients were treated with posterior approach fusion with graft and intenal fixation,2 patients with irriducible atlantoaxial dislocation were treated with occipitocervical fusion.Occipitocervical fusion was performed in 1 patient,posterior atlantal arch excision was performed in 1 patient.One irriducible atlantoaxial dislocation were treated with microscopic transoral approach C1～2 screw fixation,1 irriducible atlantoaxial dislocation(IAAD) were treated with navigation aided microscopic transoral approach combine with ventral decompression one-stage C1～2 posterior approach fusion with graft and intemal fixation,1 case of SAS secondary to AAS underwent multiple segment fusion and internal fixation.2 patients with VS were treated with occipitocervical fixation,1 routine foramen magnum decompression and internal fixation.2 subaxial subluxations (SAS) patients underent multiple segmental fixation fusion.There were 2 men and 14 women with an average age of (55.8±4.3) years (range,41～65 years).The average course of disease was (15.7±2.8) years (range,11～20years).Pain was evaluated by Visual Analogue Scale (VAS) scores before and after surgery.Ranawat grading scale,Japanese Orthopaedic Association (JOA) scores,posterior atlanto-odontoid interval (PADI),cervicomedullary angle (CMA) were used to determine myelopathy.Clinical and radiological data were collected before surgery,at 3 and (or) 6months after surgery,and at final follow-up.Results Patients were followed up for 3～36 months (23.2±3.6 months),15 cases of had a significant neurological improvement,1 cases have no improvement but also no nerve damage aggravated,16 cases of postoperative patients with odontoid pannus around a preoperative decrease.Solid fusion was confirmed by CT in all cases.No internal fixation loosening and fracture,spinal cord and nerve root and vertebral artery injury,adrenocortical crisis happened.Conclusion Individualized surgical planning should be adopted in patients with RA in upper cervical spine,which can effectively slow down the damage process cervical inflammation of rheumatoid arthritis,improve clinical outcomes,improve the quality of life.