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Title: Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients
Authors: Ito, Hiromu  kyouindb  KAKEN_id
Neo, Masashi
Sakamoto, Takeshi
Fujibayashi, Shunsuke  kyouindb  KAKEN_id
Yoshitomi, Hiroyuki  kyouindb  KAKEN_id
Nakamura, Takashi
Author's alias: 伊藤,  宣
Keywords: Atlantoaxial transarticular screw fixation
Atlantoaxial subluxation
Subaxial subluxation
Rheumatoid arthritis
Operative complications
Issue Date: Jun-2009
Publisher: Springer Verlag
Journal title: European Spine Journal
Volume: 18
Issue: 6
Start page: 869
End page: 876
Abstract: The most common cervical abnormality associated with rheumatoid arthritis (RA) is atlantoaxial subluxation, and atlantoaxial transarticular screw fixation has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation. Following C1–C2 fixation, however, subaxial subluxation reportedly can bring about neurological deterioration and require secondary operative interventions. Rheumatoid patients appear to have a higher risk, but there has been no systematic comparison between rheumatoid and non-rheumatoid patients. Contributing radiological factors to the subluxation have also not been evaluated. The objective of this study was to evaluate subaxial subluxation after atlantoaxial transarticular screw fixation in patients with and without RA and to find contributing factors. Forty-three patients who submitted to atlantoaxial transarticular screw fixation without any concomitant operation were followed up for more than 1 year. Subaxial subluxation and related radiological factors were evaluated by functional X-ray measurements. Statistical analyses showed that aggravations of subluxation of 2.5 mm or greater were more likely to occur in RA patients than in non-RA patients over an average of 4.2 years of follow-up, and postoperative subluxation occurred in the anterior direction in the upper cervical spine. X-ray evaluations revealed that such patients had a significantly smaller postoperative C2–C7 angle, and that the postoperative AA angle correlated negatively with this. Furthermore, anterior subluxation aggravation was significantly correlated with the perioperative atlantoaxial and C2–C7 angle changes, and these two changes were strongly correlated to each other. In conclusion, after atlantoaxial transarticular screw fixation, rheumatoid patients have a greater risk of developing subaxial subluxations. The increase of the atlantoaxial angel at the operation can lead to a decrease in the C2–C7 angle, followed by anterior subluxation of the upper cervical spine and possibly neurological deterioration.
Rights: c 2009 Springer-Verlag.
This is not the published version. Please cite only the published version.
DOI(Published Version): 10.1007/s00586-009-0945-5
PubMed ID: 19337758
Appears in Collections:Journal Articles

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