Abstract
Objective: To reassess whether the Ranawat IIIB (quadriparetic, non-ambulant) rheumatoid arthritis (RA) with cervical myelopathy patients should be surgically treated.
Study Design: Retrospective study
Subjects: Over a 12-year period (1988–1999), 51 patients [15 M: 36F; mean age 64 years] in Ranawat IIIB with RA were diagnosed to have cervical myelopathy. These included 47 patients with atlantoaxial subluxation (AAS) [15 with AAS alone, 10 with basilar invagination (BI), 18 with associated subaxial subluxation (SAS) and four patients with BI and SAS] and four patients with SAS alone.
Results: Thirty-two patients considered fit for surgery successfully underwent operative treatment (Group 1). All underwent posterior instrumented fixation with or without transoral odontoid peg excision. Postoperatively 22/27 patients were pain free and 21/32 patients initially non-ambulant were able to walk. 3/26 patients died within six months of surgery. 13/19 patients managed conservatively (Group 2) because of medical complications died within six months of presentation.
Conclusions: Even in advanced stages of cervical myelopathy in RA, surgical intervention is beneficial with significantly higher morbidity/mortality in conservatively managed patients.
Abstracts prepared by Mr. A. J. Stirling, FRCS, and Miss A. Weaver. Correspondence should be addressed to Miss A. Weaver at the Research and Teaching Centre, Royal Orthopaedic Hospital, Northfield, Birmingham, B31 2AP, UK
BritSpine 2002, the second combined meeting of the British Association of Spinal Surgeons, the British Cervical Spine Society, The British Scoliosis Society and the Society for Back Pain Research, took place at the International Convention Centre in Birmingham UK between 27th February and 1st March 2002. The following presentations and posters were given and displayed.
