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The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients
European Spine Journal, 05/11/09

Iizuka H et al. – Study reports that patients demonstrating bony ankylosis of the upper cervical spine facet joints with a cervical spine involvement due to rheumatoid arthritis (RA) showed severe cervical myelopathy. The occurrence of bony ankylosis was a risk factor for instability of atlanto-axial joint (AAJ), and subaxial instability or stenosis.

• An investigation of:
  • occurrence of bony ankylosis in upper cervical spine facet joints using computed tomography (CT)
  • characteristics of the pts showing such ankylosis
• 46 pts; radiographic diagnoses included:
  • Atlanto-axial subluxation (n=30)
  • Vertical subluxation (VS) (n=10)
  • VS + subaxial subluxation (n=3)
  • Cervical spondylotic myelopathy (n=3)
• Pts were classified into 2 groups, those developing bony ankylosis or not
• Differences in the patient characteristics between the 2 groups was investigated
• Cervical spine disorders and surgeries were also evaluated in pts who demonstrated such bony ankylosis

• Bony ankylosis seen in 12 pts (group BA) vs none (group NB)
• Level at which bony ankylosis occurred was:
  • Atlanto-occipital joint (AOJ) in 8 cases
  • Atlanto-axial joint (AAJ) in 2 cases and
  • AOJ, AAJ in 2 cases
• No differences were observed between the 2 groups
• No difference between 2 groups in the pts showing obvious neurological impairment
• In BA group, arthrodesis or decompression was adapted for a caudal region of bony ankylosis
• Bony ankylosis of the facet joint of the upper cervical spine was detected in 12/46 RA pts with involvement of cervical spine who thus required surgery

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