Home | About JCVJS | Editorial board | Ahead of print | Current Issue | Archives | Instructions | Subscribe | Advertise | Contact us |   Login 
Journal of Craniovertebral Junction and Spine
Search Articles   
Advanced search   
Year : 2012  |  Volume : 3  |  Issue : 2  |  Page : 42-46

The long time follow-up of craniovertebral junction fixation in patients with rheumatoid arthritis

Department of Neurosurgery, TC Istanbul Arel University Tepekent, Istanbul, Turkey

Correspondence Address:
Kadir Kotil
Hasan Ali Yücel Sok, Senil Apt. 36/14, Çiftehavuzlar Kadikoy, Istanbul, 34728
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-8237.116532

Rights and Permissions

Background: Rheumatoid arthritis (RA) can have very destructive effects, especially in the cervical spine. Bone quality is poor in these patients. The purpose of this study is to evaluate the feasibility of fusion and accuracy of fluoroscopy in cervical transpedicular fixation (CPF) in a standardized clinical protocol for RA patients. Materials and Methods: 96 pedicles of 15 patients operated between January 2000 and ay 2010 due to atlanto-axial and subaxial cervical subluxation were investigated for post-operative malposition of the transpedicular screws. Three-dimensional computed tomography was used as a useful tool in preoperative planning and in transarticular or transpedicular screw placement with the free hand technique in the cervical spine of RA patients. Fixation and reduction with fusion was performed in all of the patients, and autogrefts from iliac wing were used for fusion. Ranawat's and Nurick scales were used to assess the results. All screws were evaluated by Kast's criteria. Fusion or stability was evaluated on plain radiographs taken 3 weeks and 6, 12 and 60 months after the surgery. Results: Female to male ratio was 6/9. The mean age at the time of surgery was 57.4 years (range 44-72 years). Five of the patients were operated for both C1-2 and subaxial subluxation. Two of the 15 patients had only C1-2 subluxation and the remaining eight patients had only subaxial cervical subluxation. The screws were at their correct places in 84 pedicles (87.5.%) while minor breach was detected in 9 (10.9%). According to Ranawat's criteria, seven patients remained the same, and eight patients showed improvement. Instrumentation failure, loss of reduction or non-union was not observed at the final follow-up (average 31.5 months; range 24-60 months). Conclusion: CPF provides a very strong three column stabilization and solid fusion in the osteoporotic vertebrae, but also carries a risk of vascular injury without nerve damage or in the RA patients, but the risk is low in experienced hands.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded92    
    Comments [Add]    

Recommend this journal