F. Kerschbaumer et al., Transoral decompression, anterior plate fixation, and posterior wire fusion for irreducible atlantoaxial kyphosis in rheumatoid arthritis, SPINE, 25(20), 2000, pp. 2708-2715
Study Design. Fifteen consecutive patients with irreducible atlantoaxial ky
phosis caused by rheumatoid: arthritis were treated by combined transoral o
dontoid resection, anterior plate fixation, and posterior wire fusion.
Objectives. To investigate the clinical results of this new surgical proced
ure.
Summary and Background Data. irreducible atlantoaxial kyphosis in rheumatoi
d arthritis results from a destruction of the craniocervical joint ligament
s and the anterior aspects of the lateral atlantoaxial joints. The developm
ent of a paradental synovial pannus and atlantoaxial joint impaction preven
ts reduction by conservative treatment, such as skull traction. Posterior s
urgical procedures for the treatment of the irreducible atlantoaxial kyphos
is with spinal cord compression have been associated with high morbidity an
d mortality.
Methods. Fifteen consecutive patients were treated by transoral odontoid re
section. The fixation was: performed with anterior plating, according to th
e method of Harms in combination with posterior wire fusion according to Br
ooks. Before and after surgery, evaluation was performed using the paramete
rs of pain (visual analog scale), range of motion, and subjective assessmen
t:of improvement and the Health Assessment Questionnaire. The neurologic de
ficit was defined according to the classifications proposed by Ranawat, Fra
nkel, and Nurwick. Plain radiographs, including lateral flexion and extensi
on views, and magnetic resonance scans were obtained.
Results. No perioperative fatality occurred. The average clinical and radio
graphic follow-up was 50.7 +/- 15.6 months (range, 26-77). Postoperative pa
in was relieved (mean pain score before surgery, 7.9 +/- 1.87; after surger
y, 3.8 +/- 1.27), and the range of motion of all patients increased [mean 2
1.5 +/- 14.0 degrees for rotation; mean 17.2 +/- 5.54 degrees for bending).
The score on the Health Assessment Questionnaire increased in three patien
ts, remained unchanged in three and decreased in six patients (three had di
ed). All patients improved at least one Ranawat Lever after surgery, except
a patient in Ranawat Class II, whose condition remained unchanged. All pat
ients were satisfied with the procedure and reported subjective improvement
.
Conclusion. Transoral plate fixation combined with posterior wire fixation
after transoral odontoid resection is an effective, reliable, and safe proc
edure for the treatment of irreducible atlantoaxial kyphosis in rheumatoid
arthritis.