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Rydning PNF, Linnerud H, Mirzamohammadi J, Brommeland T, Rønning PA, Evjensvold M, Aarhus M, Bakland G, Helseth E. Decreasing incidence of cervical spine fractures in patients with ankylosing spondylitis: a population-based study in Southeast Norway. Spine J 2024:S1529-9430(24)00113-X. [PMID: 38548069 DOI: 10.1016/j.spinee.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/26/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND CONTEXT Individuals diagnosed with ankylosing spondylitis (AS) face an increased risk of spine fractures, specifically cervical spine fractures (CS-Fxs). In the past two decades, biological disease-modifying antirheumatic drugs (bDMARDs) have provided considerable relief from pain and an enhanced sense of wellbeing for a large segment of AS patients. Despite these improvements, it remains unclear whether extended use of bDMARDs can indeed reduce the risk of spine fractures. PURPOSE In this study, we aimed to investigate the evolving patterns and epidemiology of traumatic CS-Fxs in both AS and non-AS populations. We hypothesized that the risk of CS-Fxs among AS patients would show a decreasing trend over time, while the risk among non-AS patients would remain constant. STUDY DESIGN/SETTING Retrospective cohort study based on a prospective database. PATIENT SAMPLE A total of 3,598 consecutive patients with CS-Fxs were treated at Oslo University Hospital over an 8-year period. OUTCOME MEASURES CS-Fxs in AS patients were contrasted with non-AS-related CS-Fxs in terms of temporal trends, age, sex, injury mechanism, associated cervical spinal cord injury (cSCI), need for surgical fixation, and 30-day mortality. METHODS Data regarding all CS-Fxs diagnosed between 2015 and 2022 were extracted from the Southeast Norway population-based quality control database for traumatic CS-Fxs. Categorical data were summarized using frequencies, and continuous data were summarized using medians. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-squared test and Fischer exact test were used to compare categorical variables. To investigate the trend in the incidence of fractures, two different Poisson models were fitted with the number of non-AS and AS fractures as dependent variables and the year as the explanatory variable. RESULTS Over an eight-year period, we registered 3,622 CS-Fxs in 3598 patients, with AS patients accounting for 125 of these fractures. Relative to their non-AS counterparts, AS patients presented a 9-fold and 8-fold higher risk of initial and subsequent CS-Fxs, respectively. We observed a declining trend in AS-related CS-Fxs with an annual linear decrease of 8.4% (p=.026), whereas non-AS-related CS-Fxs showed an annual linear increase of 3.7% (p<.001). AS patients sustaining CS-Fxs were typically older (median age 70 vs. 63 years), predominantly male (89% vs. 67%), and more frequently experienced injuries due to falls (82% vs. 57%). They also exhibited a higher prevalence of subaxial CS-Fxs (91% vs. 62%), fewer C0-C2 CS-Fxs (14% vs. 44%), a higher rate of associated cSCI (21% vs. 11%), and a greater tendency for surgical fixation (66% vs. 21%). We observed a 30-day mortality rate of 11% in AS patients and 5.4% in non-AS patients (p=.005). CONCLUSIONS The results of this study confirm the elevated risk of CS-Fxs among AS patients, although this risk appears to show a decreasing trend. The most plausible explanation for this risk reduction is the widespread application of bDMARDs.
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Affiliation(s)
| | - Hege Linnerud
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway
| | - Jalal Mirzamohammadi
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway
| | - Pål Andre Rønning
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway
| | - Magnus Evjensvold
- Department of Neuroradiology, Oslo University Hospital, Oslo N-0424, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo N-0372, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø N-9019, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Kirkeveien 166, Oslo N-0450, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo N-0372, Norway
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Wang M, Shen J, Tan J, Zhu X, Ma H, Wen Z, Tian Y, Jiang W. Risk factors for cervical instability in rheumatoid arthritis: a meta-analysis. Arch Med Sci 2024; 20:375-383. [PMID: 38757018 PMCID: PMC11094836 DOI: 10.5114/aoms/173494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/08/2023] [Indexed: 05/18/2024] Open
Abstract
Introduction The aim of the study was to evaluate the risk factors for cervical instability in rheumatoid arthritis (RA). Material and methods Computer searches were conducted in PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI) database, the Wan Fang database, the Chinese Scientific Journal Databases (VIP) database, and the Chinese Biomedical Literature database (CBM) from their establishment until November 2022. Results A total of 8 articles were included in this study, including 1 cross-sectional study, 5 case-control studies, and 2 cohort study, including 3078 patients with RA. Meta-analysis results showed that: male sex (OR = 1.70, 95% CI: 1.19-2.42), course of disease (OR = 1.72, 95% CI: 1.29-2.28), long-term glucocorticosteroid use (OR = 2.84, 95% CI: 1.97-2.40), Steinbrocker staging (OR = 2.30, 95% CI: 1.61-3.28), disability at baseline (OR = 24.57, 95% CI: 5.51-109.60), peripheral joint destruction (OR = 2.24, 95% CI: 1.56-3.21), Steinbrocker stage I-IV progression to disability (OR = 20.08, 95% CI: 4.18-96.53), and previous joint surgery (OR = 1.54, 95% CI: 1.06-2.26) are the main risk factors for cervical instability in RA. Conclusions There are many risk factors for cervical instability in RA. In clinical practice, special attention should be paid to patients who are male, have a longer course of disease, have long-term glucocorticosteroid use, have previous joint surgery, have peripheral joint damage, and develop disability in Steinbrocker stage I-IV. Attention should be paid to the high-risk groups mentioned above, and effective measures such as early screening and full monitoring should be taken to prevent the occurrence of cervical instability in RA.
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Affiliation(s)
- Min Wang
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Jinhua Shen
- First People’s Hospital of Changde City, Changde, China
| | - Jianghong Tan
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Xiaoling Zhu
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Hongxia Ma
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Zhenhua Wen
- Department of Rheumatology and Immunology, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Yanzhen Tian
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
| | - Weimin Jiang
- Department of Nursing, Zhuzhou Hospital Affiliated to Xiangya Medical College, Central South University, Zhuzhou, Hunan, China
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Alp G, Cinakli H, Akar S, Solmaz D. Prevalence of anterior atlantoaxial subluxation and association with established rheumatoid arthritis. Musculoskeletal Care 2024; 22:e1859. [PMID: 38261795 DOI: 10.1002/msc.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/30/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Spinal involvement in rheumatoid arthritis (RA) is limited to the upper cervical spine, leading to cervical spine instability. This study aimed to evaluate the prevalence of anterior atlantoaxial subluxation (aAAS) and its associated risk factors in patients with RA. METHOD This single-centre cross-sectional study 240 patients consecutively were recruited. Radiographs of the cervical spine were obtained in the flexion and neutral neck positions and read by two blinded observers. The diagnosis of aAAS was based on the distance between the anterior aspect of the dens and the posterior aspect of the anterior arch of the atlas, which was >3 mm during flexion. Statistical analysis was performed to determine the predictive factors of aAAS. RESULTS Two hundred and forty patients with a mean ± SD age of 56.4 ± 11.4 years were recruited, and 191 (78%) were female. The mean ± SD duration of the disease was 10.2 ± 8.5 years. Of all 25 cases (10.4%) diagnosed with aAAS, the mean anterior atlantodental interval in patients with AAS was 4.19 ± 1.20 mm. One in three patients with aAAS had no neck pain. Patients with aAAS had longer disease duration, lower age at diagnosis, lower body mass index, higher anti-cyclic citrullinated peptide autoantibodies (anti-CCP), more frequent erosion, joint restriction, and joint prostheses. In the multivariate regression model, joint limitation, history of joint prostheses, low BMI, and higher anti-CCP levels were independent predictors of the aAAS. CONCLUSION Thirty-three percent of patients with cervical involvement do not experience neck pain. Cervical involvement should be considered even without neck pain, particularly in established diseases.
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Affiliation(s)
- Gülay Alp
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Haluk Cinakli
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
| | - Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi University Faculty of Medicine, Izmir, Turkey
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Jackson-Fowl B, Hockley A, Naessig S, Ahmad W, Pierce K, Smith JS, Ames C, Shaffrey C, Bennett-Caso C, Williamson TK, McFarland K, Passias PG. Adult cervical spine deformity: a state-of-the-art review. Spine Deform 2024; 12:3-23. [PMID: 37776420 DOI: 10.1007/s43390-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2023] [Indexed: 10/02/2023]
Abstract
Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.
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Affiliation(s)
- Brendan Jackson-Fowl
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Edmonton, AB, USA
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler K Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Kimberly McFarland
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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Matsuyama H, Hara M, Seto A, Hiraki T. Predictive underestimation of difficult direct laryngoscopy in a patient with rheumatoid arthritis-associated immobilized craniocervical junction. JA Clin Rep 2023; 9:85. [PMID: 38051390 DOI: 10.1186/s40981-023-00679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The upper cervical spine is a major focus of damage by rheumatoid arthritis (RA). Specific screening for mobility of the upper cervical spine, which is essential for direct laryngoscopy, is lacking. Herein, we present a case of RA with Cormack-Lehane grade IV, which was not predicted by preoperative examination. CASE PRESENTATION A 66-year-old woman with RA was scheduled for a right total knee arthroplasty and right elbow synovectomy. She had a long history of RA without symptoms related to the cervical spine or spinal cord. Although physical examination suggested moderate risk of difficult intubation with preserved cervical retroflexion, her Cormack-Lehane classification was grade IV under muscle relaxation. Bony integration of the occiput to axis was considered to be the main cause of difficult direct laryngoscopy, and restricted neck rotation was found postoperatively. CONCLUSIONS RA patients may have limited upper cervical spine motion despite normal cervical retroflexion.
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Affiliation(s)
- Hirotaka Matsuyama
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
| | - Masato Hara
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Atsushi Seto
- Nagata Orthopedic Hospital, 1-6-3 Shiranui-Machi, Omuta, Fukuoka, 836-0843, Japan
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan
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Bettaieb H, Ferjani HL, Ben Nessib D, Kaffel D, Maatallah K, Hamdi W. Predictors factors of atlanto-axial subluxation in Tunisian patients with rheumatoid arthritis. Musculoskeletal Care 2023; 21:968-975. [PMID: 36905639 DOI: 10.1002/msc.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND The aim of this study was to describe clinical and imaging features of atlantoaxial subluxation (AAS) and the associated risk factors in patients with rheumatoid arthritis (RA). METHODS We conducted a retrospective and comparative study including 51 RA patients with AAS and 51 RA patients without AAS. Atlantoaxial subluxation was defined by the presence of an anterior C1C2 diastasis on the cervical spine radiograph in hyperflexion and/or an anterior, posterior, lateral or rotatory C1C2 dislocation on MRI with/without inflammatory signal. RESULTS In G1, clinical presentations revealing AAS were mainly neck pain (68.7%) and neck stiffness (29.8%). MRI revealed: diastasis C1C2 (92.5%), periodontoid pannus (92.5%), odontoid erosion (23.5%), vertical subluxation (9.8%) and spinal cord involvement (7.8%). A collar immobilisation and corticosteroid boluses were indicated in 86.3% and 47.1% of cases. C1-C2arthrodesis was performed in 15.4% of cases. Atlantoaxial subluxation was significantly associated with: age at disease onset (p = 0.009), history of joint surgery (p = 0.012), disease duration (p = 0.001), rheumatoid factor (p = 0.01), anti-cyclic citrullinated peptide (p = 0.02), erosive radiographic status (p < 0.005), coxitis (p < 0.001), osteoporosis (p = 0.012), extra-articular manifestations (p < 0.001), and high disease activity (p = 0.001). Multivariate analysis identified RA duration (p < 0.001, OR = 1.022 CI[1.01-1.034]) and erosive radiographic status (p = 0.01, OR = 21.236 CI[2.05-219.44]) as predictive factors of AAS. CONCLUSION Our study showed that longer disease duration and joint destruction are the major predictive factors of AAS. Early treatment initiation, tight-control and regular monitoring of cervical spine involvement are required in these patients.
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Affiliation(s)
- Hiba Bettaieb
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
| | - Hanene Lassoued Ferjani
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Dhia Kaffel
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Kaouther Maatallah
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Institute of Orthopaedics, La Mannouba, Tunisia
- Faculty of Medicine of Tunis, University Tunis el Manar, La Mannouba, Tunisia
- Research Unit UR17SP04, Tunis, Tunisia
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Le Quellec A, Guyard T, Carvajal Alegria G, Ruyssen-Witrand A, Fautrel B, Flipo RM, Garrigues F, Saraux A. Prevalence and predictors of atlanto-axial subluxation in rheumatoid arthritis after 12-years' follow-up (ESPOIR Cohort). Rheumatology (Oxford) 2023; 62:2692-2699. [PMID: 36440910 DOI: 10.1093/rheumatology/keac672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/19/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Anterior atlanto-axial subluxation (AAS), defined as an anterior atlanto-dental interval ≥3 mm, can occur in RA and carries a risk of severe neurological impairments. Our objective was to determine the prevalence and predictors of radiographic aAAS after 12 years' follow-up of patients with early polyarthritis. METHODS We studied patients enrolled in the early polyarthritis cohort ESPOIR (Study and Monitoring of Early Undifferentiated Arthritis) between 2002 and 2005 (at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA, and no previous exposure to glucocorticoids or DMARDs). All patients still in the cohort after 12 years had dynamic cervical-spine radiographs taken then read by two blinded observers. To evaluate how well combinations of tests performed at baseline and 10 years predicted aAAS after 12 years, univariate analysis and multiple logistic regression procedure were applied. RESULTS Of 323 patients followed for 12 years, 15 (4.6%; 95% CI 2.8, 6.4) had aAAS. Among baseline variables, only IgA RFs were associated (P < 0.05) with aAAS (sensitivity 60%, specificity 75%). Among data collected after 10 years, oral CS therapy during the 10-year interval, treatment by DMARDs, CRP (mg/dl) and positive tests for RFs were associated with aAAS after 12 years, but only CRP and RFs remained in a model of logistic regression (combination predicted aAAS with a sensitivity of 60% for a specificity of 90%). CONCLUSION In conclusion, the prevalence of aAAS after 12 years was 4.6% in the ESPOIR cohort, with no patients having severe aAAS. Although some factors were found to be statistically associated to AAS, the event is too rare to allow a clinical relevance.
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Affiliation(s)
| | | | | | - Adeline Ruyssen-Witrand
- Centre de Rhumatologie, CHU Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, University of Toulouse 3, Toulouse, France
| | - Bruno Fautrel
- Sorbonne Université - APHP, Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France
- INSERM U1136, Paris, France
| | | | | | - Alain Saraux
- Service de Rhumatologie, CHU Brest, Brest, France
- Université de Bretagne Occidentale, INSERM (U1227), LabEx IGO, Brest, France
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Ben Tekaya A, Rezgui S, Tbini H, Bellil M, Bouden S, Rouached L, Tekaya R, Mahmoud I, Saidane O, Abdelmoula L. Risk factors for atlantoaxial dislocation in rheumatoid arthritis: A comparative study. Musculoskeletal Care 2023; 21:592-599. [PMID: 36300878 DOI: 10.1002/msc.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objective of the study was to assess clinical and imaging features of rheumatoid arthritis associated with atlantoaxial dislocation (RA-AAD) in comparison to RA without AAD (RA-C) and to identify the associated factors to AAD. METHODS This was a retrospective comparative study including RA patients over 18 years old. The control group of RA-C was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, AAD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of AAD. RESULTS A total of 120 patients were included (78 RA-AAD and 42 RA-C); sex-ratio was 0.15. Mean age was 58.55 ± 9.14 years (RA-AAD) versus 60.43 ± 10.78 years (RA-C), (p = 0.31). Regarding RA features, RA-AAD patients have significantly a higher rheumatoid factor (RF) rate (p = 0.002), extra-articular manifestations (p = 0.009) especially osteoporosis (p < 10-3 ), eye involvement (p = 0.02), coxitis (p < 0.0001), Disease Activity Score (DAS28) (p < 10-3 ), and global health status scale (HAQ) (p = 0.003). X-ray analysis showed pathologic PADI (<14 mm) in 51.6% of cases. The AADI was pathological (>3 mm) in 100% of patients with the following distribution: 67.9% between (3-6 mm) and 23.3% between (6-9 mm). Atlantoaxial dislocation (AAD) was presumed anterior (85.4%), lateral (7.3%) and rotatory (7.3%). The abnormalities observed on magnetic resonance imaging (MRI) were: C1-C2 synovitis (61%), confirmed AAD (34.1%) and basilar impression (4.9%). AAD diagnosed by cervical MRI was anterior in 89.8% of cases, lateral (5.3%) and with a double ascending and anterior component in 4.9% of cases. An immobilisation with a type C4 cervical collar was indicated for all the patients and five of them had boluses of corticosteroid (methylprednisolone 1 g/day) for three consecutive days. C1-C2 arthrodesis by trans-articular screwing was performed in four patients with neurological signs or pathological measurements on cervical MRI. The outcome was favourable in 100% of cases after surgical treatment with improvement in neck pain and neurological condition within a mean decline of 4 ± 3 years [1-7]. Multivariate analysis identified coxitis, osteoporosis, high baseline DAS28, and a high rate of RF positivity as predictive factors of AAD. CONCLUSION Our results confirmed that predictive factors of AAD were related to higher disease activity and structural damage. These modifiable factors may be prevented by tight control, early treatment, and educating RA patients to improve treatment adherence.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Soumaya Rezgui
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Houssem Tbini
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Mehdi Bellil
- Orthopedic Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Ines Mahmoud
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, Tunis, Tunisia
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Ellatif M, Sharif B, Baxter D, Saifuddin A. Update on imaging of the cervical spine in rheumatoid arthritis. Skeletal Radiol 2022; 51:1535-1551. [PMID: 35146552 DOI: 10.1007/s00256-022-04012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.
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Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK.
| | - Ban Sharif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
| | - David Baxter
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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10
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Chuang TL, Chou SC, Chen YR, Wang YF. Bone Scan With SPECT/CT Demonstrated C1 to C2 Involvement in Rheumatic Arthritis. Clin Nucl Med 2022; 47:661-663. [PMID: 35452005 PMCID: PMC9169756 DOI: 10.1097/rlu.0000000000004160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/04/2022]
Abstract
ABSTRACT An 80-year-old man was treated with rituximab for active rheumatoid arthritis until 2019, now controlled with Salazopyrin, prednisolone, methotrexate, and folic acid. However, laboratory data showed elevated C-reactive protein and erythrocyte sedimentation rate. Whole-body bone scan showed bony and joint destruction to the upper cervical vertebra (C spine), bilateral shoulders, wrists, finger joints, ankles, and left knee. SPECT/CT localized the upper C spine uptake to the C1/C2 joint and adjacent C1 and C2 with C1/C2 subluxation. C spine CT showed vertical atlantoaxial subluxation and bony erosions.
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Affiliation(s)
- Tzyy-Ling Chuang
- From the Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| | - Shih-Chin Chou
- Department of Nuclear Medicine, Chi Mei Medical Center, Liouying
| | - Yu-Ruei Chen
- Department of Medical Imaging, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yuh-Feng Wang
- From the Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
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11
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The Influence of Reducing Disease Activity Score on Cervical Spine Deformity in Rheumatoid Arthritis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9403883. [PMID: 35463987 PMCID: PMC9033349 DOI: 10.1155/2022/9403883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
Background. Rheumatoid arthritis (RA) can cause deformity in particularly the craniocervical but also in the lower cervical region. Objectives. The aim of this study is to give an overview of current literature on the association of disease activity score (DAS) and the prevalence and progression of rheumatoid arthritis-associated cervical spine deformities. Methods. A literature search was done in PubMed, Embase, and Web of Science using a sensitive search string combination (Supplemental File). Studies describing the association between DAS and the incidence and progression of atlantoaxial subluxation, vertical subluxation, and subaxial subluxation were selected by predefined selection criteria, and risk of bias was assessed using a Cochrane checklist adjusted for this purpose. Results. Twelve articles were retrieved, and risk of bias on study level was low to moderate. In the eight longitudinal studies, patients demonstrated high DAS at baseline, which decreased upon treatment with medication: cervical deformity at the end of follow-up was associated with higher DAS values. The four cross-sectional studies did not demonstrate a straightforward correlation between DAS and cervical deformity. Deformity progression was evaluated in three studies, but no convincing association with DAS was established. Conclusion. A positive association between prevalence of cervical spine deformities and high disease activity was demonstrated, but quality of evidence was low. Progression of cervical deformity in association with DAS control over time is only scarcely studied, and future investigations should focus on halting of deformity progression.
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12
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Esteller Gauxax D, Doncel-Moriano A, Martínez-Anda JJ, Cervera R, Llull L, Combalia A. Recurrent Cervical Subdural Bleeding Because of Atlantoaxial Instability in a Patient with Rheumatoid Arthritis: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00014. [PMID: 37440671 DOI: 10.2106/jbjs.cc.21.00671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
CASE Atlantoaxial instability (AAI) is a frequent complication of rheumatoid arthritis (RA), but its involvement in intracranial bleeding is unclear. We present a young woman with history of systemic lupus erythematosus and RA who developed 3 episodes of subdural bleeding at the upper cervical spine and cranial level. Imaging tests showed signs of AAI with odontoid deformity. The case was interpreted as recurrent traumatic cervical subdural hemorrhage because of AAI. No new episodes occurred after surgical C1-C2 fixation. CONCLUSION We report a case that had the association of hemorrhage and C1-2 instability in a patient with RA and lupus erythematosus.
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Affiliation(s)
| | | | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
- Institut d'Investigació Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Laura Llull
- Neurology Department, Hospital Clinic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Andrés Combalia
- Orthopaedic Surgery and Trauma Department, Hospital Clinic, Barcelona, Spain
- Institut d'Investigació Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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13
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Sakuraba K, Omori Y, Kai K, Terada K, Kobara N, Kamura S, Fujimura K, Bekki H, Ohta M, Miyahara HA, Fukushi JI. Risk factor analysis of perioperative complications in patients with rheumatoid arthritis undergoing primary cervical spine surgery. Arthritis Res Ther 2022; 24:79. [PMID: 35361268 PMCID: PMC8969231 DOI: 10.1186/s13075-022-02767-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study. Methods A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis. Results Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio]: lower height [0.928, p=0.007], higher ASA-PS [2.296, p=0.048], longer operation time [1.013, p=0.003], more bleeding volume [1.004, p=0.04], higher rates of vertical subluxation [2.914, p=0.015] and subaxial subluxation (SAS) [2.507, p=0.036], occipito-cervical (OC) fusion [3.438, p=0.023], and occipito-cervical/thoracic (long) fusion [8.021, p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915, p=0.005], higher ASA-PS [2.622, p=0.045] and long fusion [7.289, p=0.008] remained risk factors. High-dose prednisolone use [1.247, p=0.028], SAS [6.413, p=0.018], OC fusion [17.93, p=0.034], and long fusion [108.1, p<0.001] were associated with severe complications. Conclusions ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.
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Affiliation(s)
- Koji Sakuraba
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan. .,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Yuki Omori
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kazuhiro Kai
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kazumasa Terada
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Nobuo Kobara
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Satoshi Kamura
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Kenjiro Fujimura
- Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hirofumi Bekki
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Masanari Ohta
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hisa-Aki Miyahara
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Jun-Ichi Fukushi
- Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan.,Clinical Research Center, National Hospital Organization Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka, 810-8563, Japan
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14
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Drosos AA, Pelechas E, Georgiadis AN, Voulgari PV. A not-to-miss Cause of Severe Cervical Spine Pain in a Patient with Rheumatoid Arthritis: A Case-Based Review. Mediterr J Rheumatol 2021; 32:256-263. [PMID: 34964030 PMCID: PMC8693302 DOI: 10.31138/mjr.32.3.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) may affect any diarthrodial joint with a predilection on the peripheral skeleton in a symmetrical manner. When the axial skeleton is affected, it is the cervical spine (CS) that gets involved with potentially detrimental effects, if not treated promptly. Case: A 60-year-old female suffering from RA presented with severe neck pain and stiffness, difficulty of standing and walking with brisk tendon reflexes, Babinski sign positive, and clonus. Despite the high inflammatory markers and high titres of autoantibodies (rheumatoid factor and anticitrullinated protein antibodies), she never received proper treatment. She was using only paracetamol and non-steroidal anti-inflammatory drugs. Conventional radiography (CR) of CS showed extensive degenerative changes affecting the C3–C5 vertebral level. Magnetic Resonance Imaging of the neck showed sub-axial subluxation (SAS) and spinal cord compression at C3 level, and to a lesser extent, in other levels. A multi-level cervical laminectomy and spinal cord decompression were deployed with good results. To this end, literature review was performed until September 2020 and showed that the frequency of radiological findings varies substantially, ranging between 0,7–95% in different studies. The most common radiological feature is the atlanto-axial subluxation (AAS) followed by SAS. Because CS involvement can often be clinically asymptomatic, its assessment should not be forgotten by physicians and should be assessed using CR, which is an easy-to-perform technique and gives important information as a screening tool. On the other hand, RA patients need to be treated in a prompt and efficient manner in order to avoid any potentially fatal complications.
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Affiliation(s)
- Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleftherios Pelechas
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Athanasios N Georgiadis
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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15
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Kin-Hoo Koo K, Chinoy H, Creaney L, Hayton M. Inflammatory Arthropathy in the Elite Sports Athlete. Curr Sports Med Rep 2021; 20:577-583. [PMID: 34752430 DOI: 10.1249/jsr.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Elite athletes commonly present with joint pains that are attributed to overuse injuries though on occasion it can be due to an inflammatory arthropathy. The diagnostic challenge is that presenting symptoms of benign injuries are similar to inflammatory arthropathies. A holistic review of the athlete can provide clues suggestive of inflammatory arthropathy, before requesting further investigations to confirm the diagnosis. Current imaging modalities are not specific in differentiating inflammatory arthritis with other causes of joint inflammation. Prompt treatment is required to restore the athlete to an optimum level of activity and prevent career ending disability, all in adherence to the regulations of the sporting governing bodies. This review aims to highlight the importance of inflammatory arthropathy in the differentials for an athlete presenting with joint pains.
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Affiliation(s)
- Kenneth Kin-Hoo Koo
- Department of Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Salford, UNITED KINGDOM
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UNITED KINGDOM
| | - Leon Creaney
- Manchester Institute of Health & Performance (MIHP), Manchester, UNITED KINGDOM
| | - Mike Hayton
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wrightington, Wigan, UNITED KINGDOM
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16
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Tung KK, Wu YC, Chen KH, Pan CC, Lu WX, Chin NC, Shih CM, Hsu FW, Lee CH. The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study. BMC Musculoskelet Disord 2021; 22:658. [PMID: 34353311 PMCID: PMC8344185 DOI: 10.1186/s12891-021-04531-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. METHODS Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. RESULTS We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. CONCLUSIONS We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan.,Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan.,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung, Taiwan
| | - Ning-Chien Chin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.,PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Fang-Wei Hsu
- Department of Orthopedics, Kuang Tien General Hospital, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan. .,National Chung Hsing University, Taichung, Taiwan. .,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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17
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Omar AM, Pinter ZW, Streufert BD, Sebastian AS. C1-T2 decompression and fusion for C2 erosive pannus-a case report. Spinal Cord Ser Cases 2021; 7:64. [PMID: 34321454 DOI: 10.1038/s41394-021-00429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Adan M Omar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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18
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Imaging of facet joint diseases. Clin Imaging 2021; 80:167-179. [PMID: 34333352 DOI: 10.1016/j.clinimag.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/26/2021] [Accepted: 07/03/2021] [Indexed: 02/01/2023]
Abstract
Facet joints are the important articular pillars of the spine. Several pathologies can occur in and around the facet joint, including extra ossicles, traumatic dislocation, osteoarthritis, synovial cyst, axial spondyloarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, septic arthritis, and malignant and benign neoplasms. Imaging is the mainstay to detect and characterize these diseases. In this review, we discuss the anatomy and function of facet joints, imaging techniques, and the imaging findings of several facet joint diseases. This information may be helpful to radiologists to make the correct diagnosis and optimize the management of patients with facet joint diseases.
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19
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Neuroimaging findings in rheumatologic disorders. J Neurol Sci 2021; 427:117531. [PMID: 34130065 DOI: 10.1016/j.jns.2021.117531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 01/06/2023]
Abstract
Patients with rheumatological diseases may present with neurological manifestations of peripheral and/or central nervous system (CNS). Symptoms may be related to underlying rheumatological disease or CNS effects of immune-modulating drugs. Early diagnosis and therapy may help prevent serious complications. Magnetic resonance imaging (MRI), given its excellent soft tissue details, is the preferred imaging modality when evaluating patients with rheumatological disease and suspected CNS involvement. We present a review of the neuroimaging manifestations of various rheumatic diseases with emphasis on the imaging findings on MRI.
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20
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Ramiro KRB, Mystro Neto S, Veiga IG, Rosa AF, Lima MC, Tebet MA, Pasqualini W, Cavali PTM, Risso Neto MÍ. ANALYSIS OF CERVICAL SAGITTAL PARAMETERS IN PATIENTS WITH RHEUMATOID ARTHRITIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212002235702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the cervical sagittal parameters of patients with rheumatoid arthritis (RA) and compare them with the parameters obtained from healthy patients in a sample of the Brazilian population. Methods: Epidemiological data were collected and 72 radiographs of the cervical spine in the sagittal plane were evaluated by measuring the cervical sagittal parameters COG-C7 (distance measured between the center of gravity of the head and the C7 plumb line -cranial offset), C2-C7 lordosis (vertebrae from C2 to C7), T1S (T1 slope), TIA (thoracic inlet angle) and NT (neck tilt). Statistical analysis was performed using the Student’s t and chi-square tests. Results: The TIA and NT values in the RA group were 88.8° ± 12.6° and 54.5° ± 9.3°, respectively, while for the control group, they were 77.7° ± 7.9° and 50.5° ± 7.7°, respectively, the RA group values being statistically higher than the control group values (p <0.001 and p = 0.050, respectively). The values obtained for COG-C7, C2-C7 lordosis and T1S for the RA group were 9.4 ± 16.4mm, 25° ± 22.4° and 2.6° ± 10.1°, respectively, while for the control group they were 11.8 ± 17.6mm, 26.8° ± 12.5° and 30.9° ± 8.4°, respectively. Conclusions: Patients with RA present changes in the thoracic inlet parameters as compared to the control group, with a statistically significant increase in the TIA and NT values, outlining a characteristic compensatory pattern for maintaining cervical sagittal balance. Level of evidence III; Controlled cross-sectional study.
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Affiliation(s)
| | - Sylvio Mystro Neto
- Universidade Estadual de Campinas, Brazil; Hospital Alemão Oswaldo Cruz, Brazil
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21
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Nituleasa A, Liu ED, Amidon RF, Ordookhanian C, Kaloostian P. The Aging Population Faces Increased Risk for Musculoskeletal Pathologies: The Problematic Atlas-Axis Instability. Cureus 2021; 13:e15068. [PMID: 34141512 PMCID: PMC8206866 DOI: 10.7759/cureus.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2021] [Indexed: 11/13/2022] Open
Abstract
Spinal cord injury (SCI), particularly of the traumatic variety, is a relatively common condition that disproportionately affects the elderly. Cases of SCI with nontraumatic etiologies in the geriatric population have increased over the last 20 years, however. Pannus formation, resulting from chronic inflammation of the spine, is one such etiology that may progress to SCI and potentially result in rapid neurological degeneration. Here we describe a case of an elderly woman who presented with a sudden onset of quadriplegia without a history of trauma. Radiography revealed upper cervical instability and fracture due to the presence of a large erosive pannus formation. Unfortunately, in the context of severe SCI, the reversibility of neurological decline is not always guaranteed. Additionally, surgical intervention is not always appropriate, especially among the elderly population, where medical management and end-of-life care are more often delivered.
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Affiliation(s)
- Antonia Nituleasa
- Cell, Molecular, and Developmental Biology, University of California Riverside, Riverside, USA
| | - Elizabeth D Liu
- Biochemistry, University of California Riverside, Riverside, USA
| | - Ryan F Amidon
- Medicine, Medical College of Wisconsin, Milwaukee, USA
| | | | - Paul Kaloostian
- Neurological Surgery, Riverside Community Hospital, Riverside, USA
- Neurological Surgery, Paul Kaloostian M.D. Inc., Riverside, USA
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22
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Haller C, Dietrich T, Neumann T. Coincident cervical rheumatoid arthritis and CPP-D associated crowned dens syndrome. Rheumatology (Oxford) 2021; 60:2466. [PMID: 33179030 DOI: 10.1093/rheumatology/keaa538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Tobias Dietrich
- Division of Radiology, Cantonal Hospital, St Gallen, Switzerland
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23
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Leclair NK, Knopf J, Baldwin M, Forouhar F, Onyiuke H. Rheumatoid pannus presenting as a large epidural mass in the subaxial cervical spine: A case report. Neurochirurgie 2021; 68:129-132. [PMID: 33667534 DOI: 10.1016/j.neuchi.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/26/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
Rheumatoid arthritis (RA) is a debilitating inflammatory condition characterised by joint damage that affects the cervical spine most commonly at the atlantoaxial joint resulting in neck pain and myelopathy. The pathogenesis of RA involves the formation of a hyperplastic synovial tissue, termed pannus, which invades the local bone and causes osseous erosion. Here, we describe a case of rapid onset quadriparesis due to spinal cord compression at C5-C6 secondary to vertebral subluxation and mass effect from a large inflammatory pannus in the subaxial spine. Surgical decompression and resection of the subaxial pannus were performed, and the patient regained strength in all extremities. Histopathologic evaluation of the resected tissue confirmed the diagnosis of pannus over other more common epidural masses. Pannus formation commonly occurs in the peri-odontoid region; however, its presentation as a large soft tissue mass in the subaxial spine is not described in the current literature. Therefore, pannus should be considered in the differential diagnosis of epidural masses in the spine of RA patients. We use this case to discuss the pathology and radiological findings relevant to rheumatoid pannus formation in the subaxial cervical spine, as well as emphasise the importance of treatment in the context to severe degenerative disease.
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Affiliation(s)
- N K Leclair
- University of Connecticut school of medicine, 06030 Farmington, CT, United States of America.
| | - J Knopf
- University of Connecticut school of medicine, 06030 Farmington, CT, United States of America
| | - M Baldwin
- Department of radiology, UConn Health, 06030 Farmington, CT, United States of America
| | - F Forouhar
- Department of pathology, UConn Health, 06030 Farmington, CT, United States of America
| | - H Onyiuke
- Department of neurological surgery, UConn Health, 06030 Farmington, CT, United States of America.
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Cervical Spinal Fusion in Adult Patients With Rheumatoid Arthritis: A National Analysis of Complications and 90-day Readmissions. Spine (Phila Pa 1976) 2021; 46:E23-E30. [PMID: 33065691 DOI: 10.1097/brs.0000000000003753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication and 90-day readmission rates associated with cervical spinal fusion in adult patients with rheumatoid arthritis (RA). SUMMARY OF BACKGROUND RA patients who undergo cervical spine surgery are known to be at high risk for readmissions, which are costly and may not be reimbursed by Medicare. METHODS The National Readmission Database was queried for adults (>18 years) diagnosed with RA undergoing cervical spine fusion. Patient, operative, and hospital factors were assessed in bivariate analyses. Independent risk factors for readmissions were identified using stepwise multivariate logistic regression. RESULTS From 2013 to 2014, a total of 5597 RA patients (average age: 61.5 ± 11.2 years, 70.9% female) underwent cervical spine fusion. A total of 691 (12.3%) patients were readmitted within 90 days (). Index inpatient complications included dysphagia (readmitted: 7.9% vs. non-readmitted: 5.1%; P = 0.003), urinary tract infection (UTI) (8.8% vs. 3.7%; P < 0.001), respiratory-related complications (7.6% vs. 3.4%; P < 0.001), and implant-related complications (5.4% vs. 2.7%; P < 0.001). Multivariate logistic regression demonstrated the following as the strongest independent predictors for 90-day readmission: intraoperative bleeding (odds ratio [OR]: 3.6, P = 0.001), inpatient Deep Vein Thrombosis (DVT) (OR 4.1, P = 0.004), and patient discharge against medical advice (OR 33.5, P = 0.001). CONCLUSION Readmission rates for RA patients undergoing cervical spine surgery are high and most often due to postoperative infection (septicemia, UTI, pneumonia, wound). Potential modifiable factors which may improve outcomes include minimizing intraoperative blood loses, postoperative DVT prophylaxis, and discharge disposition. LEVEL OF EVIDENCE 3.
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Beyer B, Feipel V, Dugailly PM. Biomechanics of the upper cervical spine ligaments in axial rotation and flexion-extension: Considerations into the clinical framework. J Craniovertebr Junction Spine 2020; 11:217-225. [PMID: 33100772 PMCID: PMC7546058 DOI: 10.4103/jcvjs.jcvjs_78_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
Context: The motion of the upper cervical spine (UCS) has a great interest for analyzing the biomechanical features of this joint complex, especially in case of instability. Although investigators have analyzed numerous kinematics and musculoskeletal characteristics, there are still little data available regarding several suboccipital ligaments such as occipito-atlantal, atlantoaxial, and cruciform ligaments. Objective: The aim of this study is to quantify the length and moment arm magnitudes of suboccipital ligaments and to integrate data into specific 3D-model, including musculoskeletal and motion representation. Materials and Methods: Based on a recent method, suboccipital ligaments were identified using UCS anatomical modeling. Biomechanical characteristics of these anatomical structures were assessed for sagittal and transversal displacements regarding length and moment arm alterations. Results: Outcomes data indicated length alterations >25% for occipito-atlantal, atlanto-axial and apical ligaments. The length alteration of unique ligaments was negligible. Length variation was dependent on the motion direction considered. Regarding moment arm, larger magnitudes were observed for posterior ligaments, and consistent alteration was depicted for these structures. Conclusion: These outcomes supply relevant biomechanical characteristics of the UCS ligaments in flexion-extension and axial rotation by quantifying length and moment arm magnitude. Moreover, 3D anatomical modeling and motion representation can help in the process of understanding of musculoskeletal behaviors of the craniovertebral junction.
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Affiliation(s)
- Benoît Beyer
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Anatomy, Faculty of Medicine, Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique Feipel
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Anatomy, Faculty of Medicine, Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre-Michel Dugailly
- Department of Physiotherapy and Rehabilitation, Faculty of Motor Sciences, Laboratory of Functional Anatomy, Université Libre de Bruxelles, Brussels, Belgium.,Department of Osteopathy, CESPU - Escola Superior de Saùde do Vale do Ave, Famalicão, Portugal
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26
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Shlobin NA, Dahdaleh NS. Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev 2020; 44:1957-1965. [PMID: 33037539 DOI: 10.1007/s10143-020-01412-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
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Zhang S, Wang L, Bao L, Sun H, Feng F, Shan J, Tang H. Does Rheumatoid Arthritis Affect the Infection and Complications Rates of Spinal Surgery? A Systematic Review and Meta-Analysis. World Neurosurg 2020; 145:260-266. [PMID: 32977033 DOI: 10.1016/j.wneu.2020.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic autoimmune disease that produces synovial membrane inflammation and causes progressive articular damage with function loss. Some controversy exists regarding whether RA is associated with infection and complications after spinal surgery. The present study aimed to determine the effect of RA on spinal surgery infection and complications. METHODS A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. All studies that had compared patients who had undergone spinal surgery with and without RA were included in the analysis. RESULTS We found significantly greater rates statistically of complications (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20-1.70; P < 0.05) and infections (OR, 1.69; 95% CI, 1.46-1.95, P < 0.05) in those with RA than in those without RA after spinal surgery. When registry data were excluded, the results suggested that the incidence of complications (OR, 2.24; 95% CI, 0.92-5.44; P = 0.08) and infections (OR, 1.76; 95% CI, 1.50-2.07; P < 0.05) was still greater for the RA group than for the non-RA group. CONCLUSION When undergoing spinal surgery, patients with RA have a greater risk of operative complications and infection. Surgeons should be aware of these risks and appropriately plan spinal operation for patients with RA to reduce the risk of complications.
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Affiliation(s)
- Shuangjiang Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lili Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Li Bao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Haibo Sun
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fei Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianlin Shan
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Baek IW, Joo YB, Park KS, Kim KJ. Risk factors for cervical spine instability in patients with rheumatoid arthritis. Clin Rheumatol 2020; 40:547-555. [PMID: 32613395 DOI: 10.1007/s10067-020-05243-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cervical spine (C-spine) instability is a unique and significant characteristic of rheumatoid arthritis (RA) because its occurrence is not rare and it can cause compressive cervical myelopathy, which may lead to serious neurologic sequelae. This study evaluated the prevalence and risk factors of C-spine instabilities in RA patients with a focus on anti-citrullinated protein antibody (ACPA) and biologic disease-modifying antirheumatic drug (DMARD) therapies. METHODS The presence of C-spine instabilities in 1114 patients with RA was evaluated using C-spine radiographies according to the defined metrics. Multivariable logistic regression analyses were performed to identify independent predictors of C-spine instability. The initiation of biologic DMARDs was assessed via a Kaplan-Meier analysis and compared using log-rank tests. RESULTS In total, 306 (27.5%) patients presented with C-spine instabilities. The most common type was atlantoaxial subluxation (AAS; n = 199 [17.9%]). Male sex, positivity for rheumatoid factor and ACPA, erosive change in the peripheral joints, and presence of osteoporosis were independently associated with C-spine instabilities (all P < 0.05). In particular, positivity for ACPA was the most powerful risk factor (odds ratio: 2.33 [95% confidence interval: 1.37, 3.96], P = 0.002), and it was closely associated with AAS. Patients with AAS were at a higher risk for early initiation of biologic DMARDs. CONCLUSIONS Positivity for ACPA was a significant risk factor for C-spine instability, and AAS was remarkably correlated to the early initiation of biologic DMARDs, a surrogate index of poor long-term outcomes. Key Points • The presence of antibodies against citrullinated proteins was a strong risk factor for C-spine instability in patients with rheumatoid arthritis. • Atlantoaxial subluxation was significantly associated with early initiation of biologic DMARDs, a surrogate index of poor long-term outcome.
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Affiliation(s)
- In-Woon Baek
- Division of Rheumatology, Department of Internl Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Bin Joo
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Jo Kim
- Division of Rheumatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Oláh C, Kardos Z, Kostyál L, Hodosi K, Tamási L, Bereczki D, Szekanecz Z. Assessment of cervical spine involvement in rheumatoid arthritis patients in the era of biologics: a real-life, cross-sectional MRI study. Rheumatol Int 2020; 40:915-921. [PMID: 32180009 DOI: 10.1007/s00296-020-04549-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/09/2020] [Indexed: 02/03/2023]
Abstract
Cervical spine involvement may lead to severe complications in rheumatoid arthritis (RA). In the era of modern therapies, atlantoaxial subluxation (AAS) may be rare; however, it may still be detected in asymptomatic patients. The onset of myelopathy can occur at any time. Altogether 49 female RA patients were included. Among them, 15 were methotrexate treated, biologic free, while 34 patients received biologics. The patients had no cervical pain or any neurological symptoms. We assessed the first (C1) and second (C2) cervical vertebrae by 3 T magnetic resonance imaging (MRI). In addition to AAS, we also determined odontoid erosion or periodontal soft tissue thickening. We associated our MRI findings with clinical, laboratory parameters, and hand radiography. We detected anterior AAS and soft tissue thickening in one-quarter, while odontoid erosions in eight (16%) of RA patients. There were no significant differences among the therapeutic subgroups. No posterior or vertical AAS was seen. Anterior AAS was associated with higher degree of inflammation, soft tissue thickening was seen at younger age, while odontoid erosions were associated with van der Heijde-Sharp scores of the hand. None of the patients had any lesions requiring surgery. The presence of cervical involvement in RA patients with 10-11 years of disease duration is still an important and frequent phenomenon. Higher disease activity and erosive disease are associated with atlantoaxial involvement. 3 T MRI is a sensitive method to assess AAS, as well as soft tissue lesions and odontoid erosions.
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Affiliation(s)
- Csaba Oláh
- Department of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary
| | - Zsófia Kardos
- Department of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - László Kostyál
- Department of Radiology, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Katalin Hodosi
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary
| | - László Tamási
- Department of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Zoltán Szekanecz
- Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 98, Debrecen, 4032, Hungary.
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Radiological Findings of the Cervical Spine in Rheumatoid Arthritis: What a Rheumatologist Should Know. Curr Rheumatol Rep 2020; 22:19. [DOI: 10.1007/s11926-020-00894-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Tripalo Batoš A, Potočki K, Žutelija Fattorini M, Posarić V, Roić G, Gagro A. Is axial magnetic resonance imaging useful in early juvenile spondyloarthritis-preliminary report. Clin Rheumatol 2020; 39:3017-3025. [PMID: 32297033 DOI: 10.1007/s10067-020-05037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/23/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/OBJECTIVES Magnetic resonance imaging (MRI) is recommended for evaluation of changes in juvenile spondyloarthropathies (JSpA). To our knowledge, there is no previous prospective study analysing early changes on axial MRI. The objective is to investigate incidence of reparable changes on axial MRI in patients with established JSpA, lasting for less than 6 months. MATERIALS AND METHODS The pilot study included 27 patients with confirmed diagnosis of JSpA examined within 2 years. Prior to imaging, basic demographic and laboratory data and HLA-B27 were collected. Patients filled out a visual analogue scale for pain and a childhood health assessment questionnaire. A paediatric rheumatologist and a paediatric physiatrist examined patients and measured indices of flexion, extension and sagittal flexibility. Contrast-enhanced axial MRI examination and cervical x-ray were performed. Three experienced paediatric radiologists independently reviewed x-ray and MRI images of all patients. RESULTS There was no significant correlation between early changes detected on MRI and other parameters. The study revealed early changes of the cervical spine to be the most common finding. More patients had positive cervical MRI than positive sacroiliac joint (SIJ) MRI. Cervical x-ray and MRI were equally useful for diagnosis regardless of other parameters. CONCLUSION Study showed new information on axial involvement, striking cervical spine as the most involved part. The biggest study limitation is the small number of patients. Establishing early JSpA diagnosis is of utmost importance, especially in the light of novel therapy introduced in every day practice. It seems that cervical spine involvement is more represented than previously described in literature, especially in comparison with SIJ. Key Points • Contrast-enhanced MRI is considered the gold standard for detection early changes in JSpA. • Standardization of diagnostic criteria and better classification of changes using the unique scoring system for children are necessary. • It seems that cervical spine involvement is more represented than previously described in the literature, especially in comparison with SIJ involvement.
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Affiliation(s)
- Ana Tripalo Batoš
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Kristina Potočki
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia.,Department for Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Matija Žutelija Fattorini
- Department of Orthopaedic, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,Fattorini Clinic For Paediatric and Adolescent Physical Therapy and Rehabilitation, Zagreb, Croatia
| | - Vesna Posarić
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia
| | - Goran Roić
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Alenka Gagro
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia. .,Department of Pulmonology, Allergology, Immunology and Rheumatology, Department of Paediatrics, Children's Hospital Zagreb, Klaićeva 16, 10000, Zagreb, Croatia. .,Faculty of Medicine, Josip Juraj Strossmayerr, Josipa Huttlera 4, University of Osijek, Osijek, Croatia.
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Almeer G, Azzopardi C, Kho J, Gupta H, James SL, Botchu R. Anatomy and pathology of facet joint. J Orthop 2020; 22:109-117. [PMID: 32322140 DOI: 10.1016/j.jor.2020.03.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022] Open
Abstract
Facet joints are the only synovial joints in the spine and can be involved in a large number of pathological processes including arthropathy, infection, inflammation, trauma and tumour. In this review article, we present a spectrum of pathologies that arise from or involve facet joints that we have encountered in our tertiary orthopaedic and spinal centre. The objective of this review is to create an aide memoire for the general radiologist who may encounter facet joint pathology, which they may not be familiar with.
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Affiliation(s)
- G Almeer
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J Kho
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - H Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis-A Case Series of 9 Patients and A Review of the Literature. J Clin Med 2020; 9:jcm9030811. [PMID: 32191997 PMCID: PMC7141180 DOI: 10.3390/jcm9030811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 02/20/2020] [Accepted: 03/10/2020] [Indexed: 12/19/2022] Open
Abstract
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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Salaffi F, Carotti M, Di Carlo M, Sessa F, Malavolta N, Polonara G, Giovagnoni A. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med 2020; 125:654-667. [DOI: 10.1007/s11547-020-01156-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/10/2020] [Indexed: 02/07/2023]
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Posterior lumbar interbody fusion graft penetrated the lumbar thecal sac in a patient with rheumatoid arthritis: A case report. Int J Surg Case Rep 2020; 67:21-24. [PMID: 32004899 PMCID: PMC6994728 DOI: 10.1016/j.ijscr.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/23/2019] [Accepted: 01/09/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Intradural foreign bodies have been reported to be associated with disc material, tumors, and bullets following spinal gunshot injuries. In this report, we describe a case of non-union with minor trauma that caused interbody bone graft material to migrate into the intrathecal area in a patient with RA. PRESENTATION OF CASE We present the case of a 65-year-old woman visited an outpatient clinic of our hospital after experiencing progressive lower extremity weakness, and voiding and defecation difficulty after fell down several times in the past. She had a history of two spinal decompression with fixation surgeries due to spinal stenosis with a herniated intervertebral disc. She was prescribed steroids and methotrexate for the RA. The results of MRI and CT demonstrated an intradural bone graft material migration with cauda equina syndrome after revision lumbar stenosis surgery. Calcified material protruded to the intracanal area and compressed the cauda equina fiber. After the removal of fragments operation, she recovered from cauda equina symptoms. A follow-up examination two years postoperatively revealed clinical resolution of cauda equina symptoms and a return to partial walking with a cane. DISCUSSION The patient had a minor or major trauma, such as a fall, after the revision surgery. After that trauma, the patient presented with some dural injury, kyphotic position, or non-union state causing the dural penetration of the interbody fusion material. CONCLUSION The first report describing displaced PLIF graft material that penetrated the dural sac and caused cauda equina symptoms in a patient with RA. Establishing strategies to minimize these complications is indicated when treating degenerative lumbar spine conditions in patients with RA.
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Ørnbjerg LM, Østergaard M. Assessment of structural damage progression in established rheumatoid arthritis by conventional radiography, computed tomography, and magnetic resonance imaging. Best Pract Res Clin Rheumatol 2020; 33:101481. [PMID: 32001166 DOI: 10.1016/j.berh.2019.101481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Structural damage progression in patients with established rheumatoid arthritis (RA) has traditionally been assessed by conventional radiography (CR), which has proven its value in clinical practice and clinical trials over the past decades. The most prominent abnormalities visualized by CR in RA patients are erosions as a consequence of bone destruction and joint space narrowing (JSN) as a consequence of cartilage damage. Several validated scoring systems to quantify the structural joint damage and progression herein are available. Computed tomography and magnetic resonance imaging are newer, more sensitive methods for detection and monitoring of structural joint damage. A validated scoring system for magnetic resonance imaging of the hands and wrists exists, while no consensus has been reached on a scoring system for computed tomography. Structural damage identified by either CR or magnetic resonance imaging predicts a poorer disease course in patients with both early and established rheumatoid arthritis.
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Affiliation(s)
- Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
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Sandström T, Rantalaiho V, Yli-Kerttula T, Kautiainen H, Malmi T, Karjalainen A, Uusitalo T, Julkunen H, Kaipiainen-Seppänen O, Paimela L, Puolakka K, Uutela T, Möttönen T, Hannonen P, Leirisalo-Repo M, Laasonen L, Kauppi M. Cervical Spine Involvement among Patients with Rheumatoid Arthritis Treated Actively with Treat-to-target Strategy: 10-year Results of the NEO-RACo Study. J Rheumatol 2019; 47:1160-1164. [DOI: 10.3899/jrheum.190139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2019] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months.Methods.Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT 00908089).Results.There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%).Conclusion.Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.
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Shi J, Ermann J, Weissman BN, Smith SE, Mandell JC. Thinking beyond pannus: a review of retro-odontoid pseudotumor due to rheumatoid and non-rheumatoid etiologies. Skeletal Radiol 2019; 48:1511-1523. [PMID: 30868232 DOI: 10.1007/s00256-019-03187-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
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Affiliation(s)
- Junzi Shi
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Joerg Ermann
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Barbara N Weissman
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Ulutatar F, Unal-Ulutatar C, Duruoz MT. Cervical proprioceptive impairment in patients with rheumatoid arthritis. Rheumatol Int 2019; 39:2043-2051. [PMID: 31435752 DOI: 10.1007/s00296-019-04419-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/10/2019] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) involving the cervical spine can lead to various neurologic defects and impairment of proprioception is just one of them. The aim of this study was the assessment of cervical proprioception and its relation with radiographic, clinical, and functional characteristics of patients with RA. One hundred and six rheumatoid arthritis patients who diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria and age, gender, educational status matched one hundred and six healthy volunteers were enrolled in this study. Cervical joint position error test (CJPET) was applied to healthy volunteers and RA patients for cervical proprioception assessment. Fatigue, depression, balance, quality of life and balance scales were administered to all patients. Cervical radiography was used to assess cervical subluxations. Regression analysis was used for grading the factors which had relations with cervical proprioception. Mean age of patients and healthy volunteers was 51 ± 11.1 and 48.9 ± 9.2, respectively. Scores of CJPET were statistically significantly higher in RA group than healthy volunteers (p = 0.001). CJPET scores were negatively correlated with Berg balance scale findings in right rotation, left rotation, flexion and extension (rho = - 0.421,- 0.473,- 0.448,- 0.515). There was weak or not significant correlation between the scores of CJPET and fatigue, depression, and quality of life scales. Scores of CJPET in patients with atlantoaxial subluxations (AAS) were statistically significantly higher than those without AAS (p < 0.05). Regression analysis results showed that the AAS was related to impaired cervical proprioception on right and left rotations. There was no correlation between CJPET scores and functional parameters. Cervical proprioception impaired in RA patients. This impairment was related to the existence of AAS and balance problems.
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Affiliation(s)
- Firat Ulutatar
- Pain Medicine Division, PMR Department, School of Medicine, Cukurova University, Adana, Turkey.
| | - Cagri Unal-Ulutatar
- PMR Department, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Tuncay Duruoz
- Rheumatology Division, PMR Department, School of Medicine, Marmara University, Istanbul, Turkey
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Dalle Ore CL, Ames CP, Deviren V, Lau D. Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis. J Neurosurg Spine 2019. [DOI: 10.3171/2018.11.spine18927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.
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Affiliation(s)
| | | | - Vedat Deviren
- Orthopedic Surgery, University of California, San Francisco, California
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Magnetic resonance imaging of the craniovertebral junction in early rheumatoid arthritis. Skeletal Radiol 2019; 48:553-561. [PMID: 30206675 DOI: 10.1007/s00256-018-3055-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis (ERA) and to elucidate the risk profile for the individual patient. MATERIALS AND METHODS Consecutive ERA patients (disease duration < 12 months) were included in our study. A cervical spine magnetic resonance imaging (MRI) and X-rays (cervical spine, hands, wrists, and feet) were performed in all patients. The MRI features were correlated with clinical, radiological, and biochemical variables. RESULTS Fifty patients (13 men and 37 women) with a mean age of 58.2 years (range, 36-79 years) were included in the study. In 12 (24%) patients were detectable MRI findings suggestive of the craniovertebral junction involvement. Compared with patients without cervical involvement, the patients with atlantoaxial synovitis showed a significantly higher anti-citrullinated protein antibodies (ACPA) titer [mean 200.25 UI (SD 262.44) vs. mean 22.05 (SD 40.21) (p < 0.001)]; a worse Disease Activity Score 44 joints (DAS44) [mean 5.72 (SD 0.44) vs. mean 4.52 (SD 0.53) (p < 0.001)]; a worse Health Assessment Questionnaire Disability Index (HAQ-DI) [mean 1.55 (SD 0.37) vs. mean 1.09 (SD 0.33) (p < 0.001)], and a higher Simple Erosion Narrowing Score (SENS) [mean 15.83 (SD 4.52) vs. mean 7.71 (SD 3.43) (p < 0.001)]. The multivariate analysis revealed a meaningful relationship between atlantoaxial synovitis and ACPA, DAS44, and the presence of an erosive disease. CONCLUSIONS The craniovertebral junction is frequently involved in ERA patients. ACPA, high disease activity, and erosive disease at baseline are predictors of atlantoaxial involvement.
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Joyce AA, Williams JN, Shi J, Mandell JC, Isaac Z, Ermann J. Atlanto-axial Pannus in Patients with and without Rheumatoid Arthritis. J Rheumatol 2019; 46:1431-1437. [DOI: 10.3899/jrheum.181429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 12/22/2022]
Abstract
Objective.Pannus formation in the atlanto-axial joint is a well-recognized complication of rheumatoid arthritis (RA). Occasionally, atlanto-axial pannus is reported when patients without a history of RA undergo magnetic resonance imaging (MRI) of the cervical spine. We sought to further characterize these patients.Methods.The Partners HealthCare Research Patient Data Registry was free-text searched for “atlanto-axial” AND “pannus” in cervical spine MRI reports from 2001 to 2015. Cases with MRI reports describing pannus were reviewed. Clinical data were extracted by chart review in cases with confirmed atlanto-axial pannus (n = 105).Results.Twenty-nine patients (27.6%) had RA, all of whom except one carried this diagnosis at the time of the MRI scan. Only 1 of 77 patients without a history of RA was subsequently diagnosed with RA (1.3%, 95% CI 0.1–7.0%, median followup 3.6 yrs). Non-RA patients were significantly older (median age 79 vs 63 yrs, p < 0.0001), less frequently female (55% vs 86%, p = 0.0032), and more likely to have undergone prior cervical spine surgery (18% vs 0%, p = 0.016) compared with RA patients. Thirty-four non-RA patients (44.7%) either had a clinical diagnosis of calcium pyrophosphate dihydrate disease (CPPD) or imaging evidence for tissue calcification. There were no significant differences in age or sex between the CPPD subgroup and other non-RA patients. Twenty-eight patients (26.7%) underwent cervical spine surgery.Conclusion.Patients without RA diagnosis and incidental atlanto-axial pannus on cervical spine MRI are unlikely to have previously unrecognized RA. Degenerative disease and tissue calcification may contribute to pannus formation in these patients.
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Abbritti RV, Esposito F, Angileri FF, Cacciola F, Marino D, La Fata G, Gorgoglione N, Raffa G, Scibilia A, Germanò A. Endoscopic Endonasal Odontoidectomy and Posterior Fusion in a Single-Stage Surgery: Description of Surgical Technique and Outcome. ACTA NEUROCHIRURGICA. SUPPLEMENT 2019; 125:197-207. [PMID: 30610323 DOI: 10.1007/978-3-319-62515-7_29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper has been edited for clarity, correctness and consistency with our house style. Please check it carefully to make sure the intended meaning has been preserved. If the intended meaning has been inadvertently altered by the editing changes, please make any corrections needed.
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Affiliation(s)
- Rosaria Viola Abbritti
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy.
| | - Filippo Flavio Angileri
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Fabio Cacciola
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Daniele Marino
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Giuseppe La Fata
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Nicola Gorgoglione
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, Università degli Studi di Messina, Messina, Italy
| | - Antonino Scibilia
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
| | - Antonino Germanò
- Division of Neurosurgery, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, Università degli Studi di Messina, Messina, Italy
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[Cervical spine involvement in rheumatoid arthritis : Diagnostics and treatment of instability due to rheumatism]. Z Rheumatol 2018; 77:889-895. [PMID: 30421032 DOI: 10.1007/s00393-018-0564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In addition to involvement of small peripheral joints, the cervical spine is the second most affected body region in rheumatoid arthritis (RA). Due to improvement of pharmaceutical treatment in recent years, new data show that there is a decreasing prevalence of cervical involvement; however, depending on the severity of cervical lesions surgical treatment still plays an important role. The sequelae of involvement of the cervical spine are craniocervical and atlantoaxial instability, which can cause severe pain, neural deficits and even death. Multimodal conservative treatment can lead to an alleviation of pain but in cases of therapy-resistant pain or neural deficits surgical treatment alone is essential to improve patient outcome. For isolated atlantoaxial instability (AAS), atlantoaxial fusion by posterior C1-2 fixation according to Harms and Goel is the method of choice. Posterior stabilization including C0 should be avoided whenever possible due to substantial limitations in range of movement.
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Bernstein DN, Kurucan E, Menga EN, Molinari RW, Rubery PT, Mesfin A. Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients. Spine J 2018; 18:1861-1866. [PMID: 29631060 DOI: 10.1016/j.spinee.2018.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Numerous studies have analyzed the impact of rheumatoid arthritis (RA) on the cervical spine and its related surgical interventions. However, there is a paucity of literature available conducting the same analyses in patients with non-cervical spine involvement. PURPOSE The objective of this study was to compare patient characteristics, comorbidities, and complications in patients with and without RA undergoing primary non-cervical spinal fusions. STUDY DESIGN/SETTING This is a retrospective national database review. PATIENT SAMPLE A total of 52,818 patients with adult spinal deformity undergoing non-cervical spinal fusions (1,814 patients with RA and 51,004 patients without RA). OUTCOME MEASURES The outcome measures in the study include patient characteristics, as well as complication and mortality rates. MATERIALS AND METHODS Using the Nationwide Inpatient Sample from 2003 to 2014, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients aged ≥18 years old with and without RA undergoing primary non-cervical spinal fusions. Univariate analysis was used to determine patient characteristics, comorbidities, and complication values for each group. Bivariate analysis was used to compare the two groups. Significance was set at p<.05. RESULTS Patients with RA were older (p<.001), were more likely to be women (p<.001), had increased rates of osteoporosis (p<.001), had a greater percentage of their surgeries reimbursed by Medicare (p<.001), and more often had weekend admissions (p=.014). There was no difference in all the other characteristics. Patients with RA had higher rates of iron deficiency anemia, congestive heart failure, chronic pulmonary disease, depression, and fluid and electrolyte disorders (all, p<.001). Patients without RA had higher rates of alcohol abuse (p=.027). There was no difference in all the other complications. There was no difference in mortality rate (p=.99). Total complications were greater in patients with RA (p<.001). Patients with RA had higher rates of infection (p=.032), implant-related complications (p=.010), incidental durotomies (p=.001), and urinary tract infections (p<.001). No difference existed among the other complications. CONCLUSIONS Patients with RA have an increased number of comorbidities and complication rates compared with patients without RA. Such knowledge can help surgeons and patients with RA have beneficial preoperative discussions regarding outcomes.
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Affiliation(s)
- David N Bernstein
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Etka Kurucan
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Emmanuel N Menga
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Robert W Molinari
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Paul T Rubery
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Addisu Mesfin
- Department of Orthopaedic Surgery, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA.
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Berry JAD, Miulli DE, Lam B, Elia C, Minasian J, Podkovik S, Wacker MRS. The neurosurgical wound and factors that can affect cosmetic, functional, and neurological outcomes. Int Wound J 2018; 16:71-78. [PMID: 30251324 DOI: 10.1111/iwj.12993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/28/2018] [Indexed: 01/02/2023] Open
Abstract
Surgically accessing pathological lesions located within the central nervous system (CNS) frequently requires creating an incision in cosmetic regions of the head and neck. The biggest factors of surgical success typically tend to focus on the middle portion of the surgery, but a vast majority of surgical complications tend to happen towards the end of a case, during closure of the surgical site incisions. One of the most difficult complications for a surgeon to deal with is having to take a patient back to the operating room for wound breakdowns and, even worse, wound or CNS infections, which can negate all the positive outcomes from the surgery itself. In this paper, we discuss the underlying anatomy, pharmacological considerations, surgical techniques and nutritional needs necessary to help facilitate appropriate wound healing. A successful surgery begins with preoperative planning regarding the placement of the surgical incision, being cognizant of cosmetics, and the effects of possible adjuvant radiation therapy on healing incisions. We need to assess patient's medications and past medical history to make sure we can optimise conditions for proper wound reepithelialisation, such as minimizing the amount of steroids and certain antibiotics. Contrary to harmful medications, it is imperative to optimise nutritional intake with adequate supplementation and vitamin intake. The goals of this paper are to reinforce the mechanisms by which surgical wounds can fail, leading to postoperative complications, and to provide surgeons with the reminder and techniques that can help foster a more successful surgical outcome.
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Affiliation(s)
- James A D Berry
- Division of Neurosurgery, Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Dan E Miulli
- Division of Neurosurgery, Department of Surgery, Arrowhead Regional Medical Center, Colton, California
| | - Benjamin Lam
- Department of Plastic and Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Christopher Elia
- Division of Neurosurgery, Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Julia Minasian
- Department of Neurosurgery, Western University College of Osteopathic Medicine, Pomona, California
| | - Stacey Podkovik
- Division of Neurosurgery, Department of Surgery, Riverside University Health System, Moreno Valley, California
| | - Margaret R S Wacker
- Division of Neurosurgery, Department of Surgery, Arrowhead Regional Medical Center, Colton, California
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Hagege B, Tubach F, Alfaiate T, Forien M, Dieudé P, Ottaviani S. Increased rate of lumbar spondylolisthesis in rheumatoid arthritis: A case-control study. Eur J Clin Invest 2018; 48:e12991. [PMID: 29956820 DOI: 10.1111/eci.12991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to compare the prevalence of lumbar spondylolisthesis (SPL) in patients suffering from low back pain (LBP) with or without rheumatoid arthritis (RA) and to identify potential factors associated with SPL in patients with RA. METHODS We performed a case-control study. Cases and control patients had chronic LBP (more than 4 weeks). Patient with RA fulfilled the 2010 ACR/EULAR criteria. The main outcome was the presence of lumbar SPL on lumbar X-ray. The prevalence of SPL between RA and control patients was compared using chi-squared test. Potential factors associated with SPL in patients with RA were investigated by univariate and multivariate analysis, estimating odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS A total of 67 cases and 83 controls were included. Median [interquartile range] age of patients with RA was 60.0 years [51.0-72.0]; 80.6% were females; and 92.5% and 83.6% were positive for anti-citrullinated protein antibodies (ACPAs) or rheumatoid factor, respectively. Mean RA disease duration was 11.2 ± 8.7 years. SPL was more frequent in patients with RA than controls (41.8% versus 18.1%, P = 0.001). Adjusted to gender, RA was associated with increased prevalence of SPL (OR 3.15 [95% CI 1.48-6.70], P = 0.003). Among patients with RA, SPL was mainly Grade 1 (85.7%). Multivariate analysis revealed SPL is associated with increased age in patients with RA (OR 1.06 [1.02-1.11], P = 0.004). CONCLUSION In a population of patients with chronic LBP, the prevalence of lumbar SPL was higher with than without RA. SPL might be explained by synovitis of lumbar facet joints.
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Affiliation(s)
- Benjamin Hagege
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Florence Tubach
- AP-HP, Département de Biostatistiques, Santé Publique et Informatique Médicale, Hôpital Pitié-Salpêtrière, Paris, France.,CIC-EC 1425, ECEVE UMR 1123, INSERM, Paris, France
| | - Toni Alfaiate
- AP-HP, Département d'Epidémiologie, Biostatistique et Recherche Clinique, Hôpital Bichat, Paris, France
| | - Marine Forien
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Philippe Dieudé
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Service de Rhumatologie, Hôpital Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Merola JF, Espinoza LR, Fleischmann R. Distinguishing rheumatoid arthritis from psoriatic arthritis. RMD Open 2018; 4:e000656. [PMID: 30167326 PMCID: PMC6109814 DOI: 10.1136/rmdopen-2018-000656] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have key differences in clinical presentation, radiographic findings, comorbidities and pathogenesis to distinguish between these common forms of chronic inflammatory arthritis. Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA. Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis and nail dystrophy are distinctive of PsA. Patients with PsA typically have seronegative test findings for rheumatoid factor (RF) and cyclic citrullinated peptide (CCP) antibodies, while approximately 80% of patients with RA have positive findings for RF and CCP antibodies. Although there is overlap in the pathogenesis of PsA and RA, differences are also present that affect the efficacy of treatment. In PsA, levels of interleukin (IL)-1β, IL-6, IL-17, IL-22, IL-23, interferon-γ and tumour necrosis factor-α (TNF-α) are elevated, and in RA, levels of IL-1, IL-6, IL-22, IL-33, TNF-α, chemokine ligand 11 and chemokine C-X-C motif ligand 13 are elevated. Differences in the pathogenesis of RA and PsA translate into some variances in the specificity and efficacy of therapies.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology, Medicine and Rheumatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Luis R Espinoza
- Section of Rheumatology, LSU Health Sciences Center at New Orleans, New Orleans, Louisiana, USA
| | - Roy Fleischmann
- Department of Medicine, University of Texas Southwestern Medical Center, Metroplex Clinical Research Center, Dallas, Texas, USA
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Suh B, Eoh J, Shin J. Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases. Clin Orthop Surg 2018; 10:204-209. [PMID: 29854344 PMCID: PMC5964269 DOI: 10.4055/cios.2018.10.2.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. Methods We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. Results On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4–5 disc space. The mean value of the retropharyngeal space was 7.2 mm. Conclusions LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.
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Affiliation(s)
- Bogun Suh
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Jaehyung Eoh
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
| | - Jihoon Shin
- Spine Center and Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, Pohang, Korea
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50
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Abozaid HSM, El-din Hassan RA, Elmadany WA, Ismail MA, Elgendy DS, Elsayed SA, Gamal RM, Daifallah OS, Abu Alfadl EM. Is It the Age at Disease Onset or the Disease Radiological Severity That Affects Cervical Spine Involvement in Patients With Rheumatoid Arthritis? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118759688. [PMID: 35140540 PMCID: PMC8819744 DOI: 10.1177/1179544118759688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/25/2018] [Indexed: 11/25/2022]
Abstract
Background: Cervical spine involvement in patients with rheumatoid arthritis (RA) can
cause pain and disability, with a variety of neurologic signs and
symptoms. Objectives: To investigate the relationship between structural cervical spine involvement
in patients with RA with the age at disease onset and the degree of
radiologic severity of RA measured by Larsen scoring. Patients and methods: This cross-sectional study included 50 adult patients with RA. Patients who
complained or not complained from symptoms of cervical spine involvement in
RA were included; we did X-ray of the cervical spine, hands, and feet;
Larsen scoring method; disease activity score (DAS28); and Neck Disability
Index. Results: The results revealed that patients with cervical involvement tend to be
younger at their disease onset than those with no cervical involvement, as
detected by cervical X-ray. The relation was significant
P < .05 regarding all cervical involvements except for
basilar invagination. Disease radiological severity (measured by Larsen
score) significantly increases the risk for subaxial subluxation,
P = .040. All other cervical complications of RA tend
to have nonsignificant relation with disease severity. Using univariate
binary regression analysis for risk factors for cervical involvement showed
that the only probable risk factor for cervical involvement (detected by
X-ray) in patients with RA is age at disease onset. Conclusions: The early age at disease onset tends to affect cervical spine involvement in
patients with RA more than the disease radiological severity.
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Affiliation(s)
- Hanan Sayed M Abozaid
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Reham Alaa El-din Hassan
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Waleed A Elmadany
- Diagnostic Radiology Department, Faculty of Medicine, Sohag University Hospital, Sohag, Egypt
| | - Mohamed Aly Ismail
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Dalia S Elgendy
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Sahar A Elsayed
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Rania M Gamal
- Rheumatology and Rehabilitation Department, Assuit University Hospital, Assuit, Egypt
| | - Osama S Daifallah
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
| | - Esam M Abu Alfadl
- Physical Medicine Rheumatology & Rehabilitation Department, Sohag University Hospital, Sohag, Egypt
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