Mid-term results of computer-assisted cervical reconstruction for rheumatoid cervical spines

Abstract

Study designA retrospective single-center study. Summary and backgroundWe routinely have used C1–C2 transarticular and cervical pedicle screw fixations to reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions. However, there is little data on mid-term results of surgical reconstruction for rheumatoid cervical disorders, particularly, cervical pedicle screw fixation. ObjectivesThe purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions. MethodsSeventeen subjects (4 men, 13 women; mean age, 61±9years) with RA cervical lesions who underwent C1–C2 transarticular screw fixation or occipitocervical fixation, with at least 5years follow-up were studied. A frameless, stereotactic, optoelectronic, CT-based image-guidance system, was used for correct screw placement. Variables including the Japanese Orthopaedic Association (JOA) score, Ranawat class, EuroQol (EQ-5D), atlantodental interval, and Ranawat values before, and at 2 and 5years after surgery, were evaluated. Furthermore, screw perforation rates were evaluated. ResultsThe lesions included atlantoaxial subluxation (AAS, n=6), AAS+vertical subluxation (VS, n=7), and AAS+VS+subaxial subluxation (n=4). There was significant neurological improvement at 2years after surgery, as evidenced by the JOA scores, Ranawat class, and the EQ-5D utility weight. However, at 5years after surgery, there was a deterioration of this improvement. The Ranawat values before, and at 2 and 5years after surgery, were not significantly different. Major screw perforation rate was 2.1%. No neural and vascular complications associated with screw insertion were observed. ConclusionsSubjects with rheumatoid cervical lesions who underwent C1–C2 transarticular screw fixation or occipitocervical fixation using a pedicle screw had significantly improved clinical parameters at 2years after surgery. However, there was a deterioration of this improvement at 5years post surgery.