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Realignment and surgical fixation of atlanto-axial and subaxial dislocations in rheumatoid arthritis (RA) patients

Zygmunt, S C; Ljunggren, B; Alund, M; Brattstrom, H; Saveland, H G; Holtås, Stig LU ; Larsson, Elna-Marie LU and Redlund-Johnell, Inga LU (1988) In Acta Neurochirurgica. Supplementum 43. p.79-84
Abstract
One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 16 1/2 years postoperatively (mean: 4 1/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident.... (More)
One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 16 1/2 years postoperatively (mean: 4 1/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident. Following the posterior fixation, the pannus disappeared or was reduced which may at least partly explain the generally favourable operative outcome following the fixation procedure. Early occipito-cervical fusion appears to prevent further vertical dislocation or upwards migration of the odontoid which is a more severe condition, and does not appear to result in increased incidence of subsequent subaxial dislocation(s). Such luxation(s) pose a technically difficult problem since the quality of the patients' own bone usually does not permit a common anterior fusion procedure with autologous graft. In such cases with cord compression, acrylic cement may be used to obtain a normalized realignment. (Less)
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author
organization
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type
Contribution to journal
publication status
published
subject
in
Acta Neurochirurgica. Supplementum
volume
43
pages
79 - 84
publisher
Springer
external identifiers
  • pmid:3213662
  • scopus:0024196975
ISSN
0065-1419
language
English
LU publication?
yes
id
8919c4b5-c0a1-4147-80a2-3153d2aeb9f2 (old id 1104193)
date added to LUP
2008-08-07 11:55:09
date last changed
2017-01-01 07:19:29
@article{8919c4b5-c0a1-4147-80a2-3153d2aeb9f2,
  abstract     = {One hundred consecutive patients with atlanto-axial dislocation(s) were subjected to posterior occipito-cervical fusion and followed up to 16 1/2 years postoperatively (mean: 4 1/2 years). The mean age at surgery was 60.3 years. At the time of follow-up, 45 patients had died, mostly due to cardiopulmonary disease. Out of the 100 patients, 67% showed a major improvement and in an additional 14% there was a slight or moderate improvement. Some patients with a stable fusion later developed subaxial dislocation(s) necessitating an anterior fusion which in patients with RA is difficult due to poor bone quality. MRI revealed pannus formation around the odontoid peg in many patients, in several to such a degree that cord compression was evident. Following the posterior fixation, the pannus disappeared or was reduced which may at least partly explain the generally favourable operative outcome following the fixation procedure. Early occipito-cervical fusion appears to prevent further vertical dislocation or upwards migration of the odontoid which is a more severe condition, and does not appear to result in increased incidence of subsequent subaxial dislocation(s). Such luxation(s) pose a technically difficult problem since the quality of the patients' own bone usually does not permit a common anterior fusion procedure with autologous graft. In such cases with cord compression, acrylic cement may be used to obtain a normalized realignment.},
  author       = {Zygmunt, S C and Ljunggren, B and Alund, M and Brattstrom, H and Saveland, H G and Holtås, Stig and Larsson, Elna-Marie and Redlund-Johnell, Inga},
  issn         = {0065-1419},
  language     = {eng},
  pages        = {79--84},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica. Supplementum},
  title        = {Realignment and surgical fixation of atlanto-axial and subaxial dislocations in rheumatoid arthritis (RA) patients},
  volume       = {43},
  year         = {1988},
}