[Rheumatoid Instability in the Cervical Spine : Diagnostic and Therapeutic Strategies]

Overview

Journal Orthopade

Specialty Orthopedics

Date 2018 Mar 30

PMID 29594321

Citations 2

Authors

R Kothe

Affiliations

Soon will be listed here.

Abstract

Background: The involvement of the cervical spine in rheumatoid arthritis (RA) continues to be of clinical importance even in this age of biologics. Pathophysiological changes begin with an isolated atlantoaxial subluxation and may progress to a complex craniocervical and subaxial instability. The onset of cervical myelopathy can occur at any time and leads to a deterioration of the prognosis for the patient.

Therapy: Treatment of the rheumatoid cervical spine should be aimed at improvement of the symptoms and prevention of further progress of the disease. In the case of instability, this is only possible by surgical treatment. The increasing usage of biological agents has led to a change in the clinical picture of the cervical involvement in RA patients. There are fewer patients presenting with isolated atlantoaxial instability. In contrast, the number of patients with complex craniocervical and/or subaxial instabilities is increasing. Complex cervical instabilities may require a longer fusion from the occiput to the upper thoracic spine. Modern operative techniques make this complex surgery also possible in severely disabled patients with a high comorbidity.

Citing Articles

Endothelial Dysfunction and Extra-Articular Neurological Manifestations in Rheumatoid Arthritis.

Maiuolo J, Muscoli C, Gliozzi M, Musolino V, Carresi C, Paone S Biomolecules. 2021; 11(1).

PMID: 33435178 PMC: 7827097. DOI: 10.3390/biom11010081.

[Cervical spine involvement in rheumatoid arthritis : Diagnostics and treatment of instability due to rheumatism].

Janssen I, Shiban E, Meyer B Z Rheumatol. 2018; 77(10):889-895.

PMID: 30421032 DOI: 10.1007/s00393-018-0564-9.

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