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Article

Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature

1
Department of Neurosurgery, University of Geneva, 1205 Geneva, Switzerland
2
Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(3), 811; https://doi.org/10.3390/jcm9030811
Received: 1 February 2020 / Revised: 20 February 2020 / Accepted: 10 March 2020 / Published: 17 March 2020
(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)
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. View Full-Text
Keywords: cervical myelopathy; spinal cord compression; cervical spine surgery; rheumatoid arthritis (RA); cranial settling (CS); atlantoaxial subluxation (AAS); atlantoaxial instability (AAI) cervical myelopathy; spinal cord compression; cervical spine surgery; rheumatoid arthritis (RA); cranial settling (CS); atlantoaxial subluxation (AAS); atlantoaxial instability (AAI)
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MDPI and ACS Style

Janssen, I.; Nouri, A.; Tessitore, E.; Meyer, B. 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, 811. https://doi.org/10.3390/jcm9030811

AMA Style

Janssen I, Nouri A, Tessitore E, Meyer B. Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature. Journal of Clinical Medicine. 2020; 9(3):811. https://doi.org/10.3390/jcm9030811

Chicago/Turabian Style

Janssen, Insa, Aria Nouri, Enrico Tessitore, and Bernhard Meyer. 2020. "Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature" Journal of Clinical Medicine 9, no. 3: 811. https://doi.org/10.3390/jcm9030811

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