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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. T...

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Autores principales: Janssen, Insa, Nouri, Aria, Tessitore, Enrico, Meyer, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141180/
https://www.ncbi.nlm.nih.gov/pubmed/32191997
http://dx.doi.org/10.3390/jcm9030811
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author Janssen, Insa
Nouri, Aria
Tessitore, Enrico
Meyer, Bernhard
author_facet Janssen, Insa
Nouri, Aria
Tessitore, Enrico
Meyer, Bernhard
author_sort Janssen, Insa
collection PubMed
description 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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spelling pubmed-71411802020-04-10 Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature Janssen, Insa Nouri, Aria Tessitore, Enrico Meyer, Bernhard J Clin Med Article 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. MDPI 2020-03-17 /pmc/articles/PMC7141180/ /pubmed/32191997 http://dx.doi.org/10.3390/jcm9030811 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Janssen, Insa
Nouri, Aria
Tessitore, Enrico
Meyer, Bernhard
Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title_full Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title_fullStr Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title_full_unstemmed Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title_short Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature
title_sort cervical myelopathy in patients suffering from rheumatoid arthritis—a case series of 9 patients and a review of the literature
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141180/
https://www.ncbi.nlm.nih.gov/pubmed/32191997
http://dx.doi.org/10.3390/jcm9030811
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