Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions

A retrospective study of 79 patients with rheumatoid arthritis was undertaken to determine the incidence of subaxial subluxation after upper cervical fusions. Fifty-five patients had isolated axial subluxation and underwent atlantoaxial fusion. Twenty-four underwent occipitocervical fusion for atlan...

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Veröffentlicht in:Spine (Philadelphia, PA. 1976) PA. 1976), 1991-10, Vol.16 (10S), p.S486-S489
Hauptverfasser: KRAUS, D. R, PEPPELMAN, W. C, AGARWAL, A. K, DELEEUW, H. W, DONALDSON, W. F
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container_end_page S489
container_issue 10S
container_start_page S486
container_title Spine (Philadelphia, PA. 1976)
container_volume 16
creator KRAUS, D. R
PEPPELMAN, W. C
AGARWAL, A. K
DELEEUW, H. W
DONALDSON, W. F
description A retrospective study of 79 patients with rheumatoid arthritis was undertaken to determine the incidence of subaxial subluxation after upper cervical fusions. Fifty-five patients had isolated axial subluxation and underwent atlantoaxial fusion. Twenty-four underwent occipitocervical fusion for atlantoaxial subluxation and superior migration of the odontoid. The two groups were comparable in age, duration of disease, and time to follow-up (atlantoaxial fusion, 65.4 months; occipitocervical fusion, 72.6 months). Fusion rates were comparable: 80% atlantoaxial fusion and 90.1% occipitocervical fusion. Of the occipitocervical fusion patients, 36% developed subaxial subluxation requiring surgery at an average of 2.6 years after fusion. Of the atlantoaxial fusion patients, 5.5% developed subaxial subluxation requiring surgery after an average of 9 years after fusion. No patient with atlantoaxial fusion developed superior migration of the odontoid. Subaxial subluxation requiring surgery developed early in patients after occipitocervical fusion. This was not true of atlantoaxial fusion. Early atlantoaxial fusion seemed to prevent the development of superior migration of the odontoid. When occipitocervical fusion is necessary and early subaxial subluxation is present, longer fusions or occipitocervicothoracic fusion should be strongly considered.
doi_str_mv 10.1097/00007632-199110001-00006
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Of the atlantoaxial fusion patients, 5.5% developed subaxial subluxation requiring surgery after an average of 9 years after fusion. No patient with atlantoaxial fusion developed superior migration of the odontoid. Subaxial subluxation requiring surgery developed early in patients after occipitocervical fusion. This was not true of atlantoaxial fusion. Early atlantoaxial fusion seemed to prevent the development of superior migration of the odontoid. 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F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions</atitle><jtitle>Spine (Philadelphia, PA. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>1991-10-01</date><risdate>1991</risdate><volume>16</volume><issue>10S</issue><spage>S486</spage><epage>S489</epage><pages>S486-S489</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>A retrospective study of 79 patients with rheumatoid arthritis was undertaken to determine the incidence of subaxial subluxation after upper cervical fusions. Fifty-five patients had isolated axial subluxation and underwent atlantoaxial fusion. Twenty-four underwent occipitocervical fusion for atlantoaxial subluxation and superior migration of the odontoid. 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When occipitocervical fusion is necessary and early subaxial subluxation is present, longer fusions or occipitocervicothoracic fusion should be strongly considered.</abstract><cop>Philadelphia, PA</cop><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>1801258</pmid><doi>10.1097/00007632-199110001-00006</doi><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0362-2436
ispartof Spine (Philadelphia, PA. 1976), 1991-10, Vol.16 (10S), p.S486-S489
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source Journals@Ovid Ovid Autoload; MEDLINE
subjects Adult
Aged
Arthritis, Rheumatoid - complications
Atlanto-Axial Joint - diagnostic imaging
Atlanto-Axial Joint - surgery
Biological and medical sciences
Cervical Vertebrae - diagnostic imaging
Cervical Vertebrae - surgery
Diseases of the osteoarticular system
Female
Humans
Inflammatory joint diseases
Joint Dislocations - diagnostic imaging
Joint Dislocations - etiology
Joint Dislocations - surgery
Male
Medical sciences
Middle Aged
Occipital Bone - diagnostic imaging
Occipital Bone - surgery
Radiography
Retrospective Studies
Spinal Fusion
title Incidence of subaxial subluxation in patients with generalized rheumatoid arthritis who have had previous occipital cervical fusions
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