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首页> 外文期刊>Surgical neurology >Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis.
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Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis.

机译：类风湿关节炎患者颈椎关节置换手术后亚轴颈椎不稳的长期发生率。

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OBJECTIVE: Cervical spine deformities are well-known complications of RA. A 5- to 20-year follow-up of 51 consecutive rheumatoid patients who underwent posterior cervical arthrodesis is presented to evaluate the recurrence of instability and need for further surgery. METHODS: We conducted a retrospective review of the clinical features of 11 men and 40 women with an established diagnosis of RA and associated cervical deformities who underwent cervical spine surgery at the Mayo Clinic (Rochester, MN) between 1979 and 1990. Their mean age was 61 +/- 10 years (SD), and their duration of RA averaged 21 +/- 8.9 years (SD). There were 22 patients who presented with myelopathy, 7 with radiculopathy, and 22 with instabilityeck pain. There were 33 patients with AAS, 2 with SMO process into the foramen magnum, 8 with SAS, and 8 with combinations of these. Preoperative reduction was followed by decompression and fusion using wiring techniques and autologous bone graft. Postoperative halo orthosis was provided for at least 3 months. The mean follow-up was 8.3 +/- 6 years (SD). RESULTS: There were 31 patients (61%) who underwent atlantoaxial arthrodesis, 17 patients (33%) who underwent subaxial, and 3 patients (6%) who underwent occipitocervical arthrodesis. During follow-up, 39% (13/33) of patients with AAS developed nonsymptomatic (6) or symptomatic/unstable (7) SASs subsequent to C1-C2 fusion. The latter 7 patients (21%) subsequently required extension of their arthrodesis. Adjacent segment disease was most common at the C3-C4 interspace after atlantoaxial fusion in 62% (8/13). Among the 8 patients who underwent isolated cervical fusion for SAS, 1 patient (1/8, 12%) developed adjacent instability after a fall and required extension of the previous fusion. No secondary procedure was required for the 6 patients initially stabilized by C1-(C6-T1) fusions for combinations of AAS + SAS. None of the patients initially treated by C1-C2 arthrodesis for AAS progressed to SMO. CONCLUSIONS: The incidence of subaxial instability in patients with rheumatoid disease who underwent cervical arthrodesis may be higher than previously reported, indicating the need for continued follow-up in these patients. Adjacent segment disease may be most common at the C3-C4 level following atlantoaxial fusion. Early stabilization of the C1-C2 complex in the patients with AAS may potentially prevent progression of SMO.
机译：目的：颈椎畸形是RA的众所周知的并发症。提出了对51位连续类风湿病患者进行颈椎后路关节固定术的5至20年随访，以评估不稳定因素的复发和进一步手术的必要性。方法：我们对1979年至1990年间在梅奥诊所（罗切斯特，明尼苏达州）进行了颈椎手术的11例确诊为RA和相关宫颈畸形的男性和40例女性的临床特征进行了回顾性研究。他们的平均年龄为61 +/- 10年（SD），其RA病程平均为21 +/- 8.9年（SD）。有22例出现脊髓病，7例发生神经根病和22例不稳定/颈部疼痛。有33例AAS患者，2例进入大孔的SMO过程，8例SAS，8例合并这些。术前复位后，采用接线技术和自体骨移植进行减压和融合。术后至少提供了3个月的光晕矫形器。平均随访时间为8.3 +/- 6年（SD）。结果：共有31例（61％）接受了寰枢椎关节固定术，17例（33％）接受了近轴关节固定术，3例（6％）进行了枕颈关节固定术。在随访期间，有39％（13/33）的AAS患者在C1-C2融合后出现了无症状（6）或有症状/不稳定（7）的SAS。后7名患者（21％）随后需要延长关节固定术。寰枢椎融合后，C3-C4间隙最常见于邻近节段疾病，占62％（8/13）。在8例接受SAS颈椎孤立融合术的患者中，有1例（1/8，12％）跌倒后出现邻近的不稳定，需要延长先前的融合术。对于最初由C1-（C6-T1）融合物稳定化的AAS + SAS组合的6例患者，无需进行二次手术。最初通过C1-C2关节固定术治疗AAS的患者均未进展为SMO。结论：接受颈椎关节置换术的类风湿病患者亚轴不稳的发生率可能高于以前报道的水平，这表明需要对这些患者进行持续的随访。寰枢椎融合后，邻近节段疾病可能最常见于C3-C4水平。 AAS患者中C1-C2复合物的早期稳定可能会阻止SMO的发展。

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