Die operative Versorgung rheumatoider Destruktionen an der Halswirbelsäule

Zusammenfassung

Die Häufigkeit rheumatischer Veränderungen an der Halswirbelsäule ist abhängig vom Schweregrad der Grunderkrankung und führt in einer Vielzahl der Fälle zu Instabilitäten, Deformitäten, therapierefraktärem Schmerz und neurologischen Ausfällen. Durch die frühzeitige Diagnose-stellung und die kontinuierliche Kontrolle der asymptomatischen Veränderungen können schwerwiegende Veränderungen für den Patienten durch eine adäquate operative Therapie verhindert werden. Eine differenzierte Indikationsstellung ist notwendig um ein Overtreatment zu vermei-den. Die Verfahrenswahl wird durch die Pathomorphologie bestimmt und führt bei angemessenem prä-und postoperativem Management zu guten Ergebnissen.

Summary

Rheumatoid arthritis often involves the cervical spine and depending from the severity of the arthritis, it leads often to instability, deformity, intractable pain and neurological deficit. Early identification of the lesion and a closely monitoring of asymptomatic changes may protect the patient against a poor outcome by an early differentiated operative treatment. The proper selection of the patients will protect them against overtreatment. The surgical technic depends from the pathomorphological changes and leads by an adequate pre- and postoperative management to good results.

Schlüsselwörter

Rheumatoide Arthritis - Halswirbelsäule - Instabilität - operative Therapie - neurologische Ausfälle

Keywords

Rheumatoid arthritis - cervical spine - instability - operative treatment - neurological deficit

• Literatur

• 1 Bland JH. Rheumatoid arthritis of the cervical spine. J Rheumatol 1974; 1: 319-42.
• 2 Boden SD., Dodge LD., Bohlman HH., Rechtine GR. Rheumatoid arthritis of the cervical spine: a long-term analysis with predictions of paralysis and recovery. JBJS 1993; 75A: 1282-97.
• 3 Brooks AL., Jenkins EB. Atlantoaxial arthrodesis by the wedge compression method. JBJS 1978; 60A: 279-84.
• 4 Chan DP., Ngian KS., Cohen L. Posterior upper cervical fusion in rheumatoid arthritis. Spine 1992; 17: 268-72.
• 5 Clark CR. Occipitocervical fusion for the unstable rheumatoid neck. Orthopedics 1989; 12: 469-73.
• 6 Dickman CA., Sonntag VK., Papadopoulos SM., Hadley MN. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 1991; 74: 190-8.
• 7 Eulerdink F., Meijers KAE. Pathology of the cervical spine in rheumatoid arthritis: a controlled study of 44 spines. J Pathol 1976; 20: 91-6.
• 8 Fujiwara K. et al A long-term follow-up study of cervical lesions in rheumatoid arthritis. J Spinal Disord 2000; 13: 519-26.
• 9 Gallie WE. Fractures and dislocations of the cervical spine. Am J Surg 1939; 46: 495-9.
• 10 Harms J., Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 2001; 22: 2467-71.
• 11 Kraus DR. et al WF III. Incidence of subaxial sub-luxation in patients with generalized rheumatoid arthritis who had previous occipital cervical fusions. Spine 1991; 16: 486-9.
• 12 Magerl F., Seeman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In Kehr P., Weidner A. (eds) The cervical spine. Vol 1. New York: Springer-Verlag; 1987
• 13 Matsunaga S., Ijiri K., Koga H. Results of a longer than 10-year follow-up of patients with rheumatoid arthritis treated by occipitocervical fusion. Spine 2000; 25: 1749-53.
• 14 Menezes AH., van Gilder JC., Clark CR., El-Khoury G. Odontoid upward migration in rheumatoid arthritis. J Neurosurg 1985; 63: 500-9.
• 15 Mixter SJ., Osgood RB. Traumatic lesions of the atlas and axis. Ann Surg 1910; 51: 193-2007.
• 16 Moskovich R., Crockard HA., Shott S., Ransford AO. Occipitocervical stabilisation for myelpoathy in patients with rheumatoid arthritis. Implications of not bone-grafting. JBJS 2000; 82A: 349-65.
• 17 Peppelman WC., Kraus DR., Donaldson III WF., Agarwal A. Cervical spine surgery in rheumatoid arthritis: Improvement of neurologic deficit after cervical spine fusion. Spine 1993; 19: 2375-9.
• 18 Ranawat CS., O´Leary P., Pellicci P., Tsairis P., Marchisello P., Dorr L. Cervical spine fusion in rheumatoid arthritis. JBJS 1979; 61A: 1003-10.
• 19 Ransford AO., Crockard HA., Pozo JL., Thomas NP., Nelson IW. Craniocervical instability treated by contoured loop fixation. JBJS 1986; 68A: 173-7.
• 20 Santavirta S. et al Operations for the unstable cervical spine in rheumatoid arthritis. Acta Orthop Scand 1990; 61: 106-10.
• 21 Stirrat AN., Fyfe IS. Surgery of the rheumatoid cervical spine. Clin Orthop 1993; 293: 135-43.
• 22 Suchomel P. et al Transarticular fixation of C1-C2: a multicenter retrospective study. Acta Chir Orthop Traumatol Cech 2004; 71: 6-12.
• 23 Van Asselt KM. et al Outcome of cervical spine surgery in patients with rheumatoid arthritis. Ann Rheum Dis 2001; 60: 448-52.
• 24 Weissmann BN. et al Prognostic features of atlantoaxial subluxation in rheumatoid arthritis patients. Radiology 1982; 144: 745-51.
• 25 Wertheim SB., Bohlman HH. Occipitocervical fusion. JBJS 1987; 69A: 833-6.
• 26 Yoshimoto H. et al A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1-C2 fusion. Spine 2004; 29: 175-81.