Surgical Treatment of Rheumatoid Lesion at Craniocervical Junction

Authors: P. Vaněk
Authors‘ workplace: 1. LF UK a ÚVN Praha
Published in: Cesk Slov Neurol N 2012; 75/108(3): 273-282
Category: Minimonography


Rheumatoid arthritis is a chronic, systemic inflammatory disorder affecting multiple organ systems. The disorder typically manifests with chronic symetric polyarthritis resulting in destruction of joints and development of joint deformities. The craniocervical junction is the section of the spine most frequently affected by the disease. Increased ligamentous laxity is responsible for a development of craniocervical instability. Anterior atlanto-axial subluxation and cranial settling of dens axis are the most common manifestations of the instability. The instability might be responsible for the development or progression of neurological deficit, including sudden death. Early initiation of aggressive pharmacotherapy may slowdown the disease progression, although surgical treatment is the only meaningful therapeutic moda­lity in patients with radiological progression of the instability or who develop neurological deficit. Surgery may also be indicated for pain associated with the craniocervical instability and unresponsive to conservative treatment. A multidisciplinary approach is the prerequisite for optimal long-term outcome.

Key words:
craniocervical junction – rheumatoid arthritis – instability – surgical treatment


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