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

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• 作者：Masashi Uehara (1)
  Jun Takahashi (2)
  Nobuhide Ogihara (3)
  Hiroki Hirabayashi (4)
  Keijiro Mukaiyama (2)
  Shugo Kuraishi (2)
  Masayuki Shimizu (2)
  Toshimasa Futatsugi (2)
  Hiroyuki Hashidate (5)
  Hiroyuki Kato (2)
  
• 刊名：Journal of Orthopaedic Science
• 出版年：2013
• 出版时间：November 2013
• 年：2013
• 卷：18
• 期：6
• 页码：916-925
• 全文大小：
• 作者单位：Masashi Uehara (1)
  Jun Takahashi (2)
  Nobuhide Ogihara (3)
  Hiroki Hirabayashi (4)
  Keijiro Mukaiyama (2)
  Shugo Kuraishi (2)
  Masayuki Shimizu (2)
  Toshimasa Futatsugi (2)
  Hiroyuki Hashidate (5)
  Hiroyuki Kato (2)
  
  1. Department of Orthopaedic Surgery, Yodakubo Hospital, 2857 Furumachi, Nagawamachi, Chiisagatagun, Nagano, 386-0603, Japan
  2. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
  3. Department of Orthopaedic Surgery, Ina Central Hospital, 1313-1 Koshirokubo, Ina, Nagano, 396-8555, Japan
  4. Department of Orthopaedic Surgery, Marunouchi Hospital, 1-7-45 Nagisa, Matsumoto, Nagano, 390-8621, Japan
  5. Department of Orthopaedic Surgery, Shinonoi General Hospital, 666-1 Shinonoiai, Nagano, Nagano, 388-8004, Japan
  
• ISSN：1436-2023

文摘

Study design A retrospective single-center study. Summary and background We routinely have used C12 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. Objectives The purpose of this study was to evaluate the mid-term surgical results of computer-assisted cervical reconstruction for such lesions. Methods Seventeen subjects (4 men, 13 women; mean age, 619years) with RA cervical lesions who underwent C12 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. Results The 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. Conclusions Subjects with rheumatoid cervical lesions who underwent C12 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.