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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, 05/14/09

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.

Methods

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

Results

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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