Occipitocervicothoracic fixation using a hook and rod system for patients with rheumatoid cervical spine

Abstract

We retrospectively examined the outcomes of occipitocervicothoracic fixation using a hook and rod system for rheumatoid patients with cervical myelopathy in which decompression of the spinal cord and spinal fusion were performed simultaneously at multiple levels. There were 10 female patients with rheumatoid arthritis (ages 51–77 years, average 62.8 years; follow-up period 6 months to 3 years and 9 months, average 2 years and 8 months). Atlantoaxial subluxation was found in 5 patients, vertical subluxation in 4 patients, and subaxial subluxation in 8 patients. The progression of the disorder was assessed as class 4 stage 4 in 3 patients and class 3 stage 4 in 7 patients. The average time taken for surgery was 4 h 41 min, and the average volume of blood loss was 729 ml. There were no complications during surgery. One patient died of malignant lymphoma 1 month after surgery, and one patient died of heart failure 2 years and 3 months after surgery. The average Japanese Orthopaedic Association (JOA) score improved from 7.0 preoperatively to 9.5 postoperatively. Preoperative nuchal pain in 3 patients and difficulty in breathing on flexion of the cervical spine in 2 patients were improved after surgery. Good bony union was obtained in 9 patients. The exception being one patient who died of a disease unrelated to the surgery 1 month postoperatively. Occipitocervicothoracic fixation using a hook and rod system is an easy and safe procedure, and can facilitate not only good bony union, but also adequate decompression of the spinal cord with simultaneous laminoplasty because of the secure long fixation extending to the upper thoracic level and bilateral grafting of a considerable volume of bone.