Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine

1972 ◽  
Vol 37 (4) ◽  
pp. 493-497 ◽  
Author(s):  
Michael H. Sukoff ◽  
Milton M. Kadin ◽  
Terrance Moran
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Transoral Approach ◽  
Anterior Decompression ◽  
Posterior Decompression ◽  
Content Type ◽  
Transoral Decompression ◽  
Fine Print

✓ A case of rheumatoid cervical myelopathy that responded to posterior decompression and fusion is presented. Progression of the disease ultimately required anterior decompression through a transoral approach.

Radiculopathy of C-5 after anterior decompression for cervical myelopathy

2005 ◽  
Vol 3 (3) ◽  
pp. 210-217 ◽  
Author(s):  
Minoru Ikenaga ◽  
Jitsuhiko Shikata ◽  
Chiaki Tanaka
Keyword(s):  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Manual Muscle Testing ◽  
Radiographic Evaluation ◽  
Anterior Decompression ◽  
Content Type ◽  
Muscle Testing ◽  
Anterior Corpectomy ◽  
Fine Print

Object. The authors conducted a study to examine the incidence and causes of postoperative C-5 radiculopathy, and they suggest preventive methods for C-5 palsy after anterior corpectomy and fusion. Methods. The authors included in the study 18 patients with postoperative C-5 radiculopathy from 563 patients who underwent anterior decompression and fusion for cervical myelopathy. There were 10 cases of ossification of the posterior longitudinal ligament (OPLL) and eight cases of cervical spondylotic myelopathy (CSM). All patients received conservative treatment. Posttreatment full recovery was present in eight patients, and Grade 3/5 strength was documented in six in whom some weakness remained. Radiographic evaluation revealed that the C3–4 and C4–5 cord compression was significantly more severe in patients with paralysis than in those without paralysis. The incidence of paralysis was higher in patients with OPLL than in those with CSM (chi-square test, p = 0.03). The incidence of paralysis increased in parallel with the number of fusion levels (correlation coefficient r = 0.94). Multivariate analysis revealed that the final manual muscle testing (MMT) value was closely related to the preoperative MMT value (computed t value 4.17; p < 0.01) and preoperative Japanese Orthopaedic Association (JOA) score for cervical myelopathty (computed t value, 2.75; p < 0.05). Conclusions. Preexisting severe stenosis at C3–4 or C4–5 in patients with OPLL is a risk factor for paralysis. Preoperative muscle weakness and a low JOA score are factors predictive of poor recovery.

The influence of transoral odontoid resection on stability of the craniovertebral junction

1992 ◽  
Vol 77 (4) ◽  
pp. 525-530 ◽  
Author(s):  
Curtis A. Dickman ◽  
Jacqueline Locantro ◽  
Richard G. Fessler
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Destruction ◽  
Craniovertebral Junction ◽  
Transoral Surgery ◽  
Posterior Decompression ◽  
Radiographic Evidence ◽  
Content Type ◽  
Surgical Interventions ◽  
Fine Print

✓ Twenty-seven cases of craniovertebral junction compression treated with transoral surgery were reviewed to assess the influences of pathological processes and surgical interventions on spinal stability. All patients presented with signs and symptoms of spinal-cord or brain-stem dysfunction. Pathology included rheumatoid arthritis in 11 patients, congenital osseous malformations in 11, spinal fractures in two, plasmacytoma in one, osteomyelitis in one, and a gunshot injury in one. Instability was defined as clear radiographic evidence of mobile subluxation in conjunction with clinical assessment. Of 19 patients (70%) requiring internal fixation, nine underwent upper cervical fusion and 10 had occipitocervical fusion. When instability occurred, all subluxations were at the C1–2 level. There were no occipitoatlantal subluxations. Eight patients (30%) had preoperative instability of the craniovertebral junction due solely to their pathology, 11 patients (40%) suffered instability after transoral surgery, and eight (30%) were without clinical or radiographic evidence of instability (mean follow-up period 14 months). Craniovertebral junction instability predominated among patients with rheumatoid arthritis: 91% required fusion and 45% presented with pre-existing instability. Among individuals with congenital osseous malformations, 45% required fusion and only one patient (9%) had pre-existing instability. Patients who required subsequent posterior decompression of a Chiari malformation were at risk for developing instability; three of four became unstable after posterior decompression. Transoral resection of the dens, the anterior arch of C-1, and the lower clivus does not fully destabilize the spine; however, this operation may potentiate incipient pathological instability. The primary determinants of instability are the extent of pathological bone destruction, ligamentous weakening, and operative bone removal. Long-term follow-up monitoring is needed after transoral surgery to detect cases of late instability.

Cervical laminectomy without fusion in patients with rheumatoid arthritis

1999 ◽  
Vol 90 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Dan Christensson ◽  
Hans Säveland ◽  
Stefan Zygmunt ◽  
Kjell Jonsson ◽  
Urban Rydholm
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Cord Compression ◽  
Spinal Instability ◽  
Decompressive Laminectomy ◽  
Content Type ◽  
Fusion Procedure ◽  
Cervical Laminectomy ◽  
Flexion Extension ◽  
Fine Print

Object. The authors performed a prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. Methods. Because of clinical and radiographic signs of cord compression, 15 patients with rheumatoid arthritis (including one with Bechterew's disease) and severe involvement of the cervical spine underwent decompressive laminectomy without fusion performed on one or more levels. Preoperative flexion—extension radiographs demonstrated dislocation but no signs of instability at the level of cord compression. Clinical and radiological reexamination were performed twice at a median of 15 months (6–24 months) and 43 months (28–72 months) postoperatively. One patient developed severe vertical translocation 28 months after undergoing a C-1 laminectomy, which led to sudden tetraplegia. She required reoperation in which posterior fusion was performed. No signs of additional instability at the operated levels were found in the remaining 14 patients. In three patients increased but stable dislocation was demonstrated. The results of clinical examination were favorable in most patients, with improvement of neurological symptoms and less pain. Conclusions. The authors conclude that decompressive laminectomy in which the facet joints are preserved can be performed in the rheumatoid arthritis-affected cervical spine in selected patients in whom signs of cord compression are demonstrated, but in whom radiographic and preoperative signs of instability are not. Performing a simultaneous fusion procedure does not always appear necessary. Vertical translocation must be detected early, and if present, a C-1 laminectomy should be followed by occipitocervical fusion.

Long-term results of expansive open-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

2004 ◽  
Vol 1 (2) ◽  
pp. 168-174 ◽  
Author(s):  
Yuto Ogawa ◽  
Yoshiaki Toyama ◽  
Kazuhiro Chiba ◽  
Morio Matsumoto ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Long Term Results ◽  
Open Door ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

Object. Numerous surgical procedures have been developed for treatment of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, and these can be performed via three approaches: anterior, posterior, or combined anterior—posterior. The optimal approach in cases involving OPLL-induced cervical myelopathy, however, remains controversial. To address this issue, the authors assessed the benefits and limitations of expansive open-door laminoplasty for OPLL-related myelopathy by evaluating mid- and long-term clinical results. Methods. Clinical results obtained in 72 patients who underwent expansive open-door laminoplasty between 1983 and 1997 and who were followed for at least 5 years were assessed using the Japanese Orthopaedic Association (JOA) scoring system. The mean preoperative JOA score was 9.2 ± 0.4; at 3 years postoperatively, the JOA score was 14.2 ± 0.3 and the recovery rate (calculated using the Hirabayashi method) was 63.1 ± 4.5%, both having reached their highest level. These favorable results were maintained up to 5 years after surgery. An increase in cervical myelopathy due to progression of the ossified ligament was observed in only two of 30 patients who could be followed for more than 10 years. Severe surgery-related complications were not observed. Preoperative JOA score, age at the time of surgery, and duration between onset of initial symptoms and surgery affected clinical results. Conclusions. Mid-term and long-term results of expansive open-door laminoplasty were satisfactory. Considering factors that affected surgical results, early surgery is recommended for OPLL of the cervical spine.

Results of adequate posterior decompression in the relief of spondylotic cervical myelopathy

1973 ◽  
Vol 38 (6) ◽  
pp. 684-692 ◽  
Author(s):  
Charles A. Fager
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Decompression ◽  
Content Type ◽  
Spondylotic Cervical Myelopathy ◽  
Dentate Ligament ◽  
Fine Print

✓ The author reports his experience with 35 cases of spondylotic myelopathy treated by extensive laminectomy and section of the dentate ligament. After a follow-up of 1 to 7 years, 24 patients have maintained distinct improvement; in nine the disability has not improved and in two it has become worse. The technique is described, and postoperative myelograms are used to demonstrate the improvement.

Syringomyelia caused by loosening of multistrand cables following C1–2 Brooks-type fusion in the rheumatoid cervical spine

2002 ◽  
Vol 97 (3) ◽  
pp. 366-368 ◽  
Author(s):  
Jun Mizutani ◽  
Shunji Tsubouchi ◽  
Muneyoshi Fukuoka ◽  
Takanobu Otsuka ◽  
Nobuo Matsui
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Rare Case ◽  
Content Type ◽  
History Of ◽  
Good For ◽  
Fine Print

✓ The authors report a very rare case of syringomyelia caused by loosening of multistrand cable wires following C1–2 Brooks-type fusion in a 36-year-old woman with a 13-year history of rheumatoid arthritis (RA). The syrinx vanished immediately after removal of the cables, and 2 years later no recurrence of symptoms or deterioration has occurred. The authors contend that multistrand titanium cables should not be used to fix a graft-assisted C1–2 construct in patients with RA, although this material is good for fixing rods. The phenomenon observed in this case adds to our understanding of the pathogenesis of noncommunicating syringomyelia.

Atlanto-axial rotational limitation secondary to osteoid osteoma of the axis

1989 ◽  
Vol 70 (1) ◽  
pp. 129-131 ◽  
Author(s):  
Michael N. Bucci ◽  
John A. Feldenzer ◽  
William A. Phillips ◽  
Stephen S. Gebarski ◽  
Robert C. Dauser
Keyword(s):  
Cervical Spine ◽  
Physical Therapy ◽  
Osteoid Osteoma ◽  
Unusual Case ◽  
Clinical Symptoms ◽  
Transoral Approach ◽  
Content Type ◽  
Microsurgical Resection ◽  
Fine Print

✓ An unusual case of atlanto-axial rotational limitation secondary to an osteoid osteoma of the axis is presented. Transoral microsurgical resection followed by physical therapy improved the clinical symptoms. This case illustrates several unique problems within the cervical spine as well as the efficacy of the transoral approach to the axis.

One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems

1999 ◽  
Vol 90 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Kuniyoshi Abumi ◽  
Kiyoshi Kaneda ◽  
Yasuhiro Shono ◽  
Masanori Fujiya
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinal Cord Tumor ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Posterior Decompression ◽  
Content Type ◽  
One Stage ◽  
Fine Print

Object. This retrospective study was conducted to analyze the results of one-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems in 46 patients. Methods. Causes of cervical myelopathy in these 46 patients included spondylosis or ossification of the posterior longitudinal ligament, rheumatoid arthritis, metastatic or primary vertebral tumors, cervical spinal injuries, and spinal cord tumor. Thirty-three patients underwent this one-stage procedure as primary surgery. In the remaining 13 patients who had previously undergone laminectomies, the one-stage procedure was performed as salvage surgery. Cervical pedicle screws were inserted into the pedicles after probing and tapping. Graft bone was placed on the bilateral lateral masses, and pedicle screws were interconnected longitudinally by either plates or rods. Postoperatively, 26 patients showed improved neurological status (at least one grade improvement on Frankel's functional classification). There were no cases of neurological deterioration postoperatively. Solid bony fusion was obtained in all patients, except in seven patients with metastatic tumor who did not receive bone grafts. Correction of kyphosis was satisfactory. Postoperative radiological evaluation revealed that 10 (5.3%) of 190 screws inserted into the cervical vertebrae had perforated the cortex of the pedicles; however, no neurovascular complications were caused by the perforations. Conclusions. The pedicle screw fixation procedure, which does not require the lamina to be used as a stabilizing anchor, has proven to be valuable when performing one-stage posterior decompressive and reconstructive surgery in the cervical spine. The risk to neurovascular structures in this procedure, however, cannot be completely eliminated. Thorough knowledge of local anatomy and application of established surgical techniques are essential for this procedure.

Single-stage anterior—posterior decompression and stabilization for complex cervical spine disorders

2000 ◽  
Vol 93 (2) ◽  
pp. 214-221 ◽  
Author(s):  
Karl D. Schultz ◽  
Mark R. McLaughlin ◽  
Regis W. Haid ◽  
Christopher H. Comey ◽  
Gerald E. Rodts ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Single Stage ◽  
Morbidity Rate ◽  
Anterior Plate ◽  
Posterior Decompression ◽  
Content Type ◽  
Graft Extrusion ◽  
Spine Disorders ◽  
Anterior Posterior ◽  
Fine Print

Object. To evaluate the applicability and safety of single-stage combined anterior—posterior decompression and fusion for complex cervical spine disorders, the authors retrospectively reviewed 72 consecutive procedures of this type performed using a uniform technique at a single center. Methods. The indications for decompression and stabilization included: postlaminectomy kyphosis (15 patients), trauma (19 patients), spondylosis and congenital stenosis (32 patients), and ossification of the posterior longitudinal ligament (six patients). All patients underwent anterior cervical corpectomies in which allograft fibula and plates were placed, with 89% of patients undergoing two- or three-level procedures (range one–four levels). Lateral mass plating with autograft (morselized iliac crest) fusion was performed in all patients while the same anesthetic agent was still in effect. A hard cervical collar was used postoperatively in all patients (mean 13 weeks). All patients were followed for a minimum of 2 years (mean 29 months). Fusion was determined to be successful in all 72 patients (100%). Although the short-term morbidity rate reached 32%, the significant long-term morbidity rate was only 5%. At the 2-year follow-up examination, anterior cervical plate dislodgment was seen in one patient, and 16 of the 516 lateral mass screws implanted were observed to have partially backed out. However, there were no cases of nerve root injury, strut graft extrusion, or anterior plate or screw fracture. There were no clinically significant hardware complications and no patient required repeated operation. Conclusions. The combined single-stage anterior—posterior decompression, reconstruction, and instrumentation procedure represents a viable option in the treatment of a select group of patients with complex cervical spinal disorders. The technique provides immediate rigid stabilization of the cervical spine, prevents anterior plate failure or strut graft extrusion, and eliminates the need for halo immobilization postoperatively. Furthermore, a higher rate of fusion is achieved with this combined approach than with the anterior approach alone.

Laminoplasty for cervical myelopathy caused by subaxial lesions in rheumatoid arthritis

2004 ◽  
Vol 100 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Yoshihiro Mukai ◽  
Noboru Hosono ◽  
Hironobu Sakaura ◽  
Takahiro Ishii ◽  
Tsuyoshi Fuchiya ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Content Type ◽  
Subaxial Subluxation ◽  
Fine Print

Object. Although controversy exists regarding surgical treatment for rheumatoid subaxial lesions, no detailed studies have been conducted to examine the efficacy of laminoplasty in such cases. To discuss indications for laminoplasty in rheumatoid subaxial lesions, the authors retrospectively investigated clinical and radiological outcomes in patients who underwent laminoplasty for subaxial lesions. Methods. Thirty patients (11 men and 19 women) underwent laminoplasty for rheumatoid subaxial lesions. The patients were divided into those with mutilating-type rheumatoid arthritis (RA) and those with nonmutilating-type RA according to the number of eroding joints. As of final follow-up examination laminoplasty resulted in improvement of myelopathy in 24 patients (seven with mutilating- and 17 with nonmutilating-type RA) and transient or no improvement in six (five with mutilating- and one with nonmutilating-type RA). In the group with mutilating-type RA, significantly poorer results were displayed (p < 0.05). In most patients preoperative radiographs demonstrated vertebral slippage less than or equal to 5 mm at only one or two levels. Postlaminoplasty deterioration of subaxial subluxation and unfavorable alignment change occurred significantly more often in patients with mutilating-type RA (p < 0.05). Conclusions. Patients with nonmutilating-type RA can benefit from laminoplasty for myelopathy due to subaxial lesions.

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