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Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation

1986; British Editorial Society of Bone & Joint Surgery; Volume: 68-B; Issue: 3 Linguagem: Inglês

10.1302/0301-620x.68b3.3733795

2044-5377

H. Alan Crockard, JL Pozo, AO Ransford, Stevens Jm, B. E. Kendall, W. K. Essigman,

Cervical and Thoracic Myelopathy

Cervical myelopathy is an uncommon but potentially fatal complication of rheumatoid atlanto-axial subluxation. Computerised myelotomography with three-dimensional reconstruction shows that rheumatoid pannus, together with the odontoid peg, contributes significantly to anterior cervico-medullary compression. These findings were the basis for treatment by transoral anterior decompression and posterior occipitocervical fusion, which removes both bony and soft-tissue causes of compression and allows early mobilisation without major external fixation. We report encouraging results from this combined approach in 14 patients who had progressive neurological deterioration.