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Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery.

Gillick JL, Wainwright J, Das K - Int J Rheumatol (2015)

Bottom Line: Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, NY Medical College, 19 Skyline Drive, Hawthorne, NY 10532, USA.

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.

No MeSH data available.


Related in: MedlinePlus

AP (a) and lateral (b) X-rays depicting an occipitocervical fusion.
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fig9: AP (a) and lateral (b) X-rays depicting an occipitocervical fusion.

Mentions: In some cases, the AAI may occur posteriorly as well, resulting in dorsal compression and kinking of the spinal cord. In these cases, occipitocervical fusion may be employed [54]. In addition, this technique may also be preferred in cases in which AAS has progressed to cranial settling and vertical migration of the dens [55]. Grob first described the current technique used in 1991, which involves occipital plating and cervical screws (Figure 9) [47]. Furthermore, the dorsal compression due to a persistent pannus may necessitate a C1 laminectomy, in which case an occipitocervical fusion may be necessary.


Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery.

Gillick JL, Wainwright J, Das K - Int J Rheumatol (2015)

AP (a) and lateral (b) X-rays depicting an occipitocervical fusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553335&req=5

fig9: AP (a) and lateral (b) X-rays depicting an occipitocervical fusion.
Mentions: In some cases, the AAI may occur posteriorly as well, resulting in dorsal compression and kinking of the spinal cord. In these cases, occipitocervical fusion may be employed [54]. In addition, this technique may also be preferred in cases in which AAS has progressed to cranial settling and vertical migration of the dens [55]. Grob first described the current technique used in 1991, which involves occipital plating and cervical screws (Figure 9) [47]. Furthermore, the dorsal compression due to a persistent pannus may necessitate a C1 laminectomy, in which case an occipitocervical fusion may be necessary.

Bottom Line: Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, NY Medical College, 19 Skyline Drive, Hawthorne, NY 10532, USA.

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.

No MeSH data available.


Related in: MedlinePlus