Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature

Cervical myelopathy occurs in approximately 2.5% of patients suffering from rheumatoid arthritis (RA) and is associated with notable morbidity and mortality. However, the surgical management of patients affected by cervical involvement in the setting of RA remains challenging and not well studied. To address this, we conducted a retrospective analysis of our clinical database between May 2007 and April 2017, and report on nine patients suffering from cervical myelopathy due to RA. We included patients treated surgically for cervical myelopathy on the basis of diagnosed RA. Clinical findings, treatment and outcome were assessed and reported. In addition, we conducted a narrative review of the literature. Four patients were male. Mean age was 64.8 ± 20.5 years. Underlying cervical pathology was anterior atlantoaxial instability (AAI) associated with retrodental pannus in four cases, anterior atlantoaxial subluxation (AAS) in two cases and basilar invagination in three cases. All patients received surgical treatment via posterior fixation, and in addition two of these cases were combined with a transnasal approach. Preoperative modified Japanese orthopaedic association scale (mJOA) improved from 12 ± 2.4 to 14.6 ± 1.89 at a mean follow-up at 18.8 ± 23.3 months (range 3–60 months) in five patients. In four patients, no follow up was available, and the mJOA of these patients at time of discharge was stable compared to the preoperative score. One patient died two days after surgery, where a pulmonary embolism was assumed to be the cause of mortality, and one patient sustained a temporary worsening of his neurological deficit postoperatively. Surgery is generally an effective treatment method in patients with inflammatory arthropathies of the cervical spine. Given the nature of the RA and potential instability, fixation in addition to cord decompression is generally required.

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Fluoroscopy-Assisted C1–C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients

Medicina ◽

10.3390/medicina58010114 ◽

2022 ◽

Vol 58 (1) ◽

pp. 114

Author(s):

Charles Tatter ◽

Alexander Fletcher-Sandersjöö ◽

Oscar Persson ◽

Gustav Burström ◽

Erik Edström ◽

...

Keyword(s):

Cohort Study ◽

Case Series ◽

Atlantoaxial Instability ◽

Posterior Fixation ◽

Single Center ◽

3D Navigation ◽

Preoperative Symptom ◽

C2 Fixation ◽

Screw Malposition

Background and Objectives: Posterior C1–C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1–C2 fixation, using TAS or CRS, between 2005–2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88 to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1–C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.

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Surgical Outcomes in Patients Operated for Cervical Myelopathy using Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

10.13107/bbj.2020.v01i01.005 ◽

2020 ◽

Vol 1 (1) ◽

Keyword(s):

Surgical Outcomes ◽

Cervical Myelopathy ◽

Negative Impact ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Case Series ◽

Bladder Function ◽

Fine Motor ◽

Evaluation Questionnaire

Study Design: This was a retrospective case series. Objective: The objective of the study was to assess the surgical outcomes of patients with cervical myelopathy, using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Summary of Background Data: Degenerative cervical myelopathy (DCM) is a leading cause of morbidity. Patients present with spasticity, gait imbalance, and loss of fine motor function. Most patients present early; however, few manage with disability for years and present late. Methods: Fifty-two consecutive patients underwent surgery for cervical myelopathy from 2008 to 2013; however, detailed follow-up was available in only 42 patients. Thirty-nine patients were ambulatory, while 3 were non-ambulatory at the outset. Nineteen patients underwent anterior surgery and 23 patients underwent posterior surgery. Frankel, Nurick grades, Neck Disability Index (NDI), and JOACMEQ scores were recorded at time of admission, 6, 12, 24, and 52 weeks, and then annually. Outcomes at final follow-up were included for statistical analysis. Results: Thirty-four (81%) patients improved, 4 (9.5%) patients remained static, and 4 (9.5%) patients worsened according to Nurick scale. Nurick grades improved from 3.52 to 1.64. Mean NDI scores improved from 42.28 to 20.28. Analyzing the JOACMEQ scores, cervical spine function improved in 15 (35.7%), upper extremity (UE) function improved in 33 (78.6%) patients, while lower extremity (LE) function improved in 32 (76.2%) patients. Bladder function improved in 17 (40.47%). Quality of life improved in 37 (88.1%) patients. LE improved more than UE, in the younger (<45 years) group, and in those with subaxial myelopathy. Pre-operative symptoms greater than 12 months had a negative impact on outcome. Pre-operative neurology, approach, and instrumentation did not impact outcomes. Four (9.5%) patients developed major neurological deficit, 4 (9.5%) patients had C5 deltoid palsy, while 1 patient had

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Failed Latarjet procedure: a systematic review of surgery revision options

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00587-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Matteo Buda ◽

Riccardo D’Ambrosi ◽

Enrico Bellato ◽

Davide Blonna ◽

Alessandro Cappellari ◽

...

Keyword(s):

Systematic Review ◽

Case Series ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Level Of Evidence ◽

Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

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SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽

10.1142/s0218810413500202 ◽

2013 ◽

Vol 18 (02) ◽

pp. 175-178 ◽

Cited By ~ 7

Author(s):

A. S. C. Bidwai ◽

F. Cashin ◽

A. Richards ◽

D. J. Brown

Keyword(s):

Rheumatoid Arthritis ◽

Pain Relief ◽

Surgical Intervention ◽

Case Series ◽

High Rate ◽

Wound Breakdown ◽

Radial Forearm ◽

Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

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Sinus Floor Augmentation—Associated Surgical Ciliated Cysts: Case Series and a Systematic Review of the Literature

Applied Sciences ◽

10.3390/app11041903 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1903

Author(s):

Adrian Kahn ◽

Shlomo Matalon ◽

Rahaf Bassam Salem ◽

Lazar Kats ◽

Liat Chaushu ◽

...

Keyword(s):

Systematic Review ◽

Microscopic Examination ◽

Literature Search ◽

Case Series ◽

Systematic Literature Search ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Sinus Floor Augmentation ◽

Sinus Floor

This study aimed to characterize the demographic and clinical features of underreported surgical ciliated cysts developing after sinus floor augmentation, based on a series of cases from our files and a systematic review of the literature. A series of five cases (four patients) of microscopically confirmed surgical ciliated cysts following sinus floor augmentation procedures from our files are described. A systematic literature search (1991–2020) with strict clinical-, radiological- and microscopic-based exclusion and inclusion criteria was performed to detect additional similar cases. The systematic review revealed only five cases that fulfilled the inclusion criteria. Altogether, surgical ciliated cysts associated with sinus floor augmentation have been rarely reported in the literature, and have not been characterized either demographically or clinically. Graft materials were diverse, implants were placed simultaneously, or up to two years post-augmentation. The associated surgical ciliated cysts developed between 0.5 and 10 years post-augmentation. Although limited in its extent, this study is the first series to characterize possible underreported sequelae of surgical ciliated cysts associated with sinus floor augmentation. It emphasizes the need for long post-operative follow-up and confirmation of lesion by microscopic examination.

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Cervical myelopathy due to atraumatic odontoid fracture in patients with rheumatoid arthritis: A case series

Modern Rheumatology ◽

10.3109/14397595.2015.1029222 ◽

2015 ◽

Vol 27 (5) ◽

pp. 901-904 ◽

Cited By ~ 1

Author(s):

Masahiko Takahata ◽

Kuniyoshi Abumi ◽

Hideki Sudo ◽

Ken Nagahama ◽

Norimasa Iwasaki

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Myelopathy ◽

Case Series ◽

Odontoid Fracture

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Atlantoaxial instability in Dyggve-Melchior-Clausen syndrome

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.96.1.0112 ◽

2002 ◽

Vol 96 (1) ◽

pp. 112-117 ◽

Cited By ~ 2

Author(s):

Frank Kandziora ◽

Luitgard Neumann ◽

Klaus John Schnake ◽

Cyrus Khodadadyan-Klostermann ◽

Stefan Rehart ◽

...

Keyword(s):

Screw Fixation ◽

Cord Compression ◽

Atlantoaxial Instability ◽

Posterior Fixation ◽

Content Type ◽

First Case ◽

Solid Fusion ◽

Specific Care ◽

Preventable Complication

✓ Dyggve-Melchior-Clausen (DMC) syndrome is a very rare disease. Only 58 cases have been reported in the literature. The syndrome is probably an autosomal recessive inherited disorder, one that is characterized by mental retardation, the short-spine type of dwarfism, and skeletal abnormalities, especially of the spine, hands, and pelvis. Atlantoaxial instability— induced spinal cord compression is a serious and preventable complication. The purpose of this report is to describe the first case of DMC syndrome in which anterior transarticular atlantoaxial screw fixation was used to treat atlantoaxial instability. The authors report on a 17-year-old man with DMC syndrome and concomitant severe atlantoaxial instability. Computerized tomography scanning and magnetic resonance angiography demonstrated an irregular course of the vertebral artery (VA) at C-2, which made a posterior fixation procedure impossible. Additionally, transoral fusion was impossible because the patient was unable to open his mouth sufficiently. Therefore, the patient underwent anterior transarticular screw fixation. Follow-up examination 36 weeks after surgery showed solid fusion without implant failure. In conclusion, treatment of atlantoaxial instability in DMC syndrome must be considered. Specific care must be taken to determine the course of the VA. If posterior and transoral fusion are impossible, anterior transarticular atlantoaxial screw fixation might be the only alternative.

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Overgrowth syndrome in neonates: a rare case series with a review of the literature

BMJ Case Reports ◽

10.1136/bcr-2018-225640 ◽

2019 ◽

Vol 12 (1) ◽

pp. e225640

Author(s):

Aakash Pandita ◽

Astha Panghal ◽

Girish Gupta ◽

Kirti M Naranje

Keyword(s):

Lower Limb ◽

Rare Case ◽

Case Series ◽

Port Wine Stain ◽

Port Wine ◽

Review Of The Literature ◽

Term Neonates ◽

Overgrowth Syndrome ◽

Klippel Trenaunay Syndrome

We present here two-term neonates presenting with right lower limb hypertrophy, a port-wine stain, acral abnormalities and clubfeet. These neonates had overlapping features of Klippel Trenaunay syndrome and congenital lipomatous overgrowth, vascular malformation, epidermal nevi and scoliosis/skeletal abnormalities. Such overgrowth syndrome has not been previously described in the literature. Both the neonates are doing well and are under regular follow-up.

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Early Clinical Results of Arthroscopically Assisted Drilling via the Radius in a Distal-to-Proximal Direction for Osteochondritis Dissecans of the Elbow

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119868937 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986893

Author(s):

Yuji Arai ◽

Kunio Hara ◽

Hiroaki Inoue ◽

Ginjiro Minami ◽

Yoshikazu Kida ◽

...

Keyword(s):

Range Of Motion ◽

Osteochondritis Dissecans ◽

Japanese Orthopaedic Association ◽

Case Series ◽

Return To Sport ◽

Functional Scores ◽

Arthroscopically Assisted ◽

The Mean ◽

Flexion And Extension

Background: We have previously reported the technique of arthroscopically assisted drilling of osteochondritis dissecans (OCD) lesions of the elbow via the radius in a distal-to-proximal direction. With this technique, the entire OCD lesion can be drilled vertically under arthroscopic guidance with pronation and supination of the forearm and flexion and extension of the elbow joint. Purpose: To retrospectively evaluate return to sport, range of motion, and the Japanese Orthopaedic Association–Japan Elbow Society Elbow Function Score (JOA-JES score) after treatment of an elbow OCD lesion by drilling through the radius. Study Design: Case series; Level of evidence, 4. Methods: From November 2003 to January 2006, a total of 7 male adolescent baseball players with OCD lesions of the elbow were treated through use of arthroscopically assisted drilling via the radius. The stage of the OCD lesion was evaluated based on preoperative plain radiographs. Patients were observed for a minimum of 36 months, and clinical analysis included time for return to sport, elbow range of motion, and the JOA-JES score before intervention and at final follow-up. Results: We evaluated all 7 patients at a mean follow-up time of 36.1 months (range, 24-68 months). The stage of the OCD lesion on plain radiography was “translucent” in 1 patient, “sclerotic” in 5 patients, and “loosening” in 1 patient. The mean range of motion before surgery was 131.2° and –4.7° in flexion and extension, respectively, and this improved to 138.6° and 1.1° at final follow-up. The improvement in extension was statistically significant ( P = .04). The mean JOA-JES score of 83.0 before surgery significantly improved to 94.0 at final follow-up ( P < .001). One patient required excision of a free body at 51 months postoperatively, but all patients returned to sports early and without pain at an average of 4.6 months postoperatively. No feature of osteoarthrosis was noted on radiography on the final examination in any patient. Conclusion: The findings of this study demonstrate that arthroscopically assisted drilling of an elbow OCD lesion through the radial head allows for early return to sporting activities as well as improved motion and functional scores.

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Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

Neuro-Oncology Practice ◽

10.1093/nop/npx002 ◽

2017 ◽

Vol 4 (4) ◽

pp. 255-262

Author(s):

Ryan Rhome ◽

Isabelle M Germano ◽

Ren-Dih Sheu ◽

Sheryl Green

Keyword(s):

Systematic Review ◽

Literature Review ◽

Case Series ◽

Tumor Control ◽

Pituitary Neoplasms ◽

Review Of The Literature ◽

Biochemical Control ◽

Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

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