A Study of Salvage Surgery after Posterior Atlantoaxial Fusion in RA Cases.

概要

論文の詳細を見る
This study reports five cases with rheumatoid arthritis requiring salvage surgery after posterior atlantoaxial fusion.Patients were divided into two groups, the first group included two nonunion and one malunion of atlantoaxial fusion and the second group included two who develope subaxial subluxation.In the first group, one case of nonunion could be again treated by atlantoaxial fusion after removing the primary grafted bone and reduction of subluxation. But the other nonunion case, and the patient with malunion needed occipitocervical fusion to be performed because their subluxation could not be reduced. After surgery, occipitocervical pain disappeared in all cases of the first group, but myelopathy persisted in the two cases treated with occipitocervical fusion.In the second group, MRI revealed severe compression of the spinal cord at subaxial level in both cases. They were treated with anterior decompression and fusion followed by posterior decompression and fusion. Regardless of the spinal cord decompression shown on MRI one case with a long history of myelopathy prior to surgery did not recover remarkably.For improvement of myelopathy and preservation of the atlantooccipital joint, it is important to closely observe and treat the loss of correction as early as possible.
西日本整形・災害外科学会の論文