Surgical treatment of the rheumatoid cervical spine in patients aged 70 years or older.

OBJECTIVE To investigate whether surgery is appropriate for elderly rheumatoid arthritis patients who are already approaching their statistical life expectancy. PATIENTS AND METHODS The subjects were 10 patients who underwent cervical spine surgery for rheumatoid arthritis at an age of over 70 yr. The pain grade and neurological deficit class according to Ranawat, peri-operative complications, causes of death and pre-operative cardiopulmonary function were assessed. RESULTS Good pain relief was achieved. Relief of pain enabled the patients, who could not sit up even in bed because of intolerable neck pain, to ride in a wheel chair without using a neck collar. Only one death was related to surgery. Pre-operative cardiopulmonary function was not significantly different compared with that of elderly patients undergoing other surgical procedures. CONCLUSION Surgery is a valuable option for the management of elderly patients with rheumatoid cervical spine since it can improve the quality of life.

[1]  S. Matsunaga,et al.  Results of a Longer Than 10-Year Follow-Up of Patients With Rheumatoid Arthritis Treated by Occipitocervical Fusion , 2000, Spine.

[2]  R. Madhok,et al.  Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years , 2000, Annals of the rheumatic diseases.

[3]  S. Shott,et al.  Occipitocervical Stabilization for Myelopathy in Patients with Rheumatoid Arthritis. Implications of Not Bone-Grafting* , 2000, The Journal of bone and joint surgery. American volume.

[4]  S. Rantapää-Dahlqvist,et al.  Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset. , 1999, The Journal of rheumatology.

[5]  K. Doi,et al.  Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. , 1999, Spine.

[6]  M. Boissier,et al.  Mortality in rheumatoid arthritis. , 1999, Revue du rhumatisme.

[7]  D. Grob,et al.  Occipitocervical fusion in patients with rheumatoid arthritis. , 1999, Clinical orthopaedics and related research.

[8]  H. Matsuzaki,et al.  C1—C2 Intra-articular Screw Fixation for Atlantoaxial Posterior Stabilization , 1999, Spine.

[9]  Y. Matsuda,et al.  Outcomes of surgical treatment for cervical myelopathy in patients more than 75 years of age. , 1999, Spine.

[10]  D. Grob.  Posterior occipitocervical fusion in rheumatoid arthritis and other instabilities , 1998, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[11]  M. Eleraky,et al.  Posterior atlantoaxial facet screw fixation in rheumatoid arthritis. , 1998, Journal of neurosurgery.

[12]  K. Eyres,et al.  Posterior surgical treatment for the rheumatoid cervical spine. , 1998, British journal of rheumatology.

[13]  D. Grob,et al.  Atlantoaxial Fusion and Retrodental Pannus in Rheumatoid Arthritis , 1997, Spine.

[14]  B. Larsson,et al.  Subaxial cervical spine subluxation in rheumatoid arthritis. A retrospective analysis of 16 operated patients after 1-5 years. , 1997, Acta orthopaedica Scandinavica.

[15]  Baker Dm.  Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. , 1997 .

[16]  J. Stevens,et al.  Predictors of outcome in the quadriparetic nonambulatory myelopathic patient with rheumatoid arthritis: a prospective study of 55 surgically treated Ranawat class IIIb patients. , 1996, Journal of Neurosurgery.

[17]  J. Bland,et al.  Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient—too much, too late? , 1996, The Lancet.

[18]  G. Nuki,et al.  Cervical spine surgery in patients with rheumatoid arthritis: an appraisal. , 1996, Annals of the rheumatic diseases.

[19]  M. Panjabi,et al.  The Role of Plate and Screw Fixation in Occipitocervical Fusion in Rheumatoid Arthritis , 1994, Spine.

[20]  W. Donaldson,et al.  Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion. , 1993, Spine.

[21]  G. Rechtine,et al.  Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery. , 1993, The Journal of bone and joint surgery. American volume.

[22]  A. Stirrat,et al.  Surgery of the rheumatoid cervical spine. Correlation of the pathology and prognosis. , 1993, Clinical orthopaedics and related research.

[23]  D. Chan,et al.  Posterior Upper Cervical Fusion in Rheumatoid Arthritis , 1992, Spine.

[24]  M. Aebi,et al.  Atlanto-axial fusion with transarticular screw fixation. , 1991, The Journal of bone and joint surgery. British volume.

[25]  H. Kudo,et al.  Surgical treatment of subaxial cervical myelopathy in rheumatoid arthritis. , 1991, The Journal of bone and joint surgery. British volume.

[26]  I. Kelly,et al.  Surgery of the rheumatoid cervical spine. , 1990, Annals of the rheumatic diseases.

[27]  H. Crockard,et al.  One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation. , 1990, The Journal of bone and joint surgery. British volume.

[28]  C. Clark,et al.  Arthrodesis of the cervical spine in rheumatoid arthritis. , 1989, The Journal of bone and joint surgery. American volume.

[29]  H. Tsuji,et al.  Occipito-cervical fusion reinforced by Luque's segmental spinal instrumentation for rheumatoid diseases. , 1988, Spine.

[30]  G. Wilde,et al.  The use of Acrylic Bone Cement for Cervical Fusion in Patients with Rheumatoid Arthritis , 1988, Journal of the Royal Society of Medicine.

[31]  A. Hockley,et al.  A new method of occipitocervical fusion using internal fixation. , 1987, Neurosurgery.

[32]  S. Larsson,et al.  Posterior Fusion for Atlanto-Axial Subluxation in Rheumatoid Arthritis , 1986, Spine.

[33]  J. Stevens,et al.  Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. , 1986, The Journal of bone and joint surgery. British volume.

[34]  J. Stevens,et al.  Surgical treatment of cervical cord compression in rheumatoid arthritis. , 1985, Annals of the rheumatic diseases.

[35]  R. Thompson,et al.  Posterior Surgical Stabilization for Atlantoaxial Subluxation in Rheumatoid Arthritis , 1985, Spine.

[36]  S. Lipson.  Rheumatoid Arthritis of the Cervical Spine , 1984, Clinical orthopaedics and related research.

[37]  C. Ranawat,et al.  Methylmethacrylate stabilization for enhancement of posterior cervical arthrodesis in rheumatoid arthritis. , 1982, The Journal of bone and joint surgery. American volume.

[38]  J. Conaty,et al.  Cervical fusion in rheumatoid arthritis. , 1981, The Journal of bone and joint surgery. American volume.

[39]  C. Ranawat,et al.  A prospective study of the progression of rheumatoid arthritis of the cervical spine. , 1981, The Journal of bone and joint surgery. American volume.

[40]  C. Ranawat,et al.  Cervical spine fusion in rheumatoid arthritis. , 1979, The Journal of bone and joint surgery. American volume.

[41]  L. Granholm,et al.  Atlanto-axial fusion in rheumatoid arthritis. A new method of fixation with wire and bone cement. , 1976, Acta orthopaedica Scandinavica.

[42]  D. Ferlic,et al.  Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis. , 1975, The Journal of bone and joint surgery. American volume.

[43]  W. Luyendijk,et al.  Dislocation of the cervical spine with cord compression in rheumatoid arthritis. , 1974, The Journal of bone and joint surgery. British volume.

[44]  Conlon Pw,et al.  Rheumatoid arthritis of the cervical spine. An analysis of 333 cases. , 1966 .

[45]  O. Steinbrocker,et al.  Therapeutic criteria in rheumatoid arthritis. , 1949, Journal of the American Medical Association.

[46]  D. Grob,et al.  Posterior occipito-cervical fusion in rheumatoid arthritis , 2004, Archives of Orthopaedic and Trauma Surgery.

[47]  S. Toksvig-Larsen,et al.  Hyperthermia during occipito-cervical fusion with acrylic cement. Epidural thermometry in 23 cases. , 1992, Acta orthopaedica Scandinavica.

[48]  C. Dickman,et al.  Atlantoaxial stabilization in rheumatoid arthritis. , 1991, Journal of neurosurgery.

[49]  S. Santavirta,et al.  Ten-year results of operations for rheumatoid cervical spine disorders. , 1991, The Journal of bone and joint surgery. British volume.

[50]  D. Hamblen,et al.  Surgical stabilisation of the rheumatoid cervical spine. A review of indications and results. , 1987, The Journal of bone and joint surgery. British volume.

[51]  H. Brattström.  Surgery in atlanto-axial dislocation in rheumatoid arthritis. , 1981, Reconstruction surgery and traumatology.