C1–C2 TRANSARTICULAR SCREW FIXATION FOR ATLANTOAXIAL INSTABILITY DUE TO RHEUMATOID ARTHRITIS: ANALYSIS OF OUTCOME.

Abstract

Objective: To review the clinical outcome of 37 consecutive patients undergoing C1– C2 transarticular fixation for patients with Rheumatoid Arthritis.

Design: Prospective Observational Study.

Methods: There were 37 patients at 2 centres. Age range was 37– 82 years. The time since diagnosis to treatment was 2– 23 years. Clinical presentation included suboccipital pain in 26/ 37 patients and neck pain in 29/37 patients. 22 patients had presented with myelopathy ( Ranawat grade II or III A). The preoperative imaging included Plain X Rays, CT scans and MRI scans. All patients underwent C1/ C2 transarticular screws ( Stealth guided) except 4 patients in which an aberrant course of the vertebral artery was identified.

Outcome measures: Functional outcome, Complications, Postoperative Neurological Status, Neck Disability index, Myelopathy disability index.

Results: 1 patient had died at 12 month followup. Neck pain improved in 22( 75%) of patients by > 5 points on the VAS. Suboccipital pain had improved in all patients. 17 patients (80%) improved following operation on the Ranawat Grading, 2 patient were worse and 3 patients remained the same.

> 70% patients reported improvement in neck disability index and > 50% patients reported improvement in myelopathy disability index.

Conclusions: C1/ C2 Transarticular fixation with spinal navigation is a safe technique for treating atlantoaxial instability in patients with Rheumatoid Arthritis. This study demonstrates improvement in all domains including neck disability, myelopathy scores and functional outcome.