Review article

SPINAL SURGERY IN INFLAMMATORY RHEUMATIC DISEASE

Darko Perović ; Klinička bolnica Dubrava, Zagreb, Hrvatska

Abstract

The most significant inflammatory rheumatic diseases of the spine are rheumatoid arthritis (RA) and spondyloarthritis disease (SpA). In patients with RA, the pathological changes mostly affect the synovial joints of the cervical spine and cause an unstable spine (subluxation). The most common type of anatomical cervical spine deformity is atlantoaxial subluxation (AAS), followed by vertical subluxation (VS), and subaxial subluxation (SS). These anatomical deformities may cause neck pain and spinal cord or brainstem compression, with resultant neurological deficits such as cervical myelopathy, paresis, and even death. Early surgery may reduce the symptoms, neurological impairment,and mortality rate. AAS can be treated by atlantoaxial transarticular fixation or posterolateral fixation-fusion of the atlantoaxial segment. VS can be fixed by occipitocervical fusion and SS by posterior cervical fusion. Rheumatoid pathological changes increase the risk for the development of degenerative spondylolistesis (dSPL) or adult spinal deformities (ASD); operative treatment is performed according to protocols for degenerative spinal disorders. Ankylosing spondylitis (AS) is an axial spondyloarthritis which presents with ossifi cation of the axial skeleton ligaments, ankylosis of the vertebral joints, osteoporosis, and kyphotic spine deformity. Clinical manifestations are: 1. limited mobility of the spine; 2. spinal deformity with imbalance; and 3. unstable horizontal spine fractures. The major goals of AS surgery are stopping the natural course of progressive deformity, restoring the horizontal visual axis and global balance, improving disability, relieving the pain resulting from muscle fatigue, and improving respiratory function. The most commonly performed operative treatment is wedge closing osteotomy by pedicle subtraction osteotomy (PSO) with long internal fixation. Spine fracture in AS should be diagnosed in time and treated by surgery due to the marked instability of the fracture associated with an increased risk of neurological deterioration and pseudoarthrosis. Th e fracture operation is based on long segment fixation. Inflammatory changes in other forms of SpA rarely cause changes in the axial skeleton which require surgical treatment.

Keywords

Rheumatoid arthritis; Cervical vertebrae; Joint dislocations; Atlanto-axial joint; Occipital bone; Ankylosing spondylitis; Spinal fractures; Lumbar vertebrae; Spinal fusion; Osteotomy

Hrčak ID:

212238

URI

https://hrcak.srce.hr/212238

Publication date:

6.12.2018.

Article data in other languages: croatian

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