Résumé
Près de 20% des patients atteints d'arthrite rhumatoïde se plaignent de problèmes cervicaux liés à l'instabilité et aux déformations. La douleur, la myélopathie, et de graves déficits neurologiques peuvent en être les conséquences fâcheuses. Les résultats rapportés dans la littérature n'encouragent pas à réaliser la décompression et la stabilisation chirurgicales. Cependant de nouvelles techniques chirurgicales permettent une stratégie plus aggressive vis-à-vis des problèmes complexes posés par l'instabilité rhumatoïde du rachis cervical. L'instabilité C1-C2, la plus fréquente, est traitée sans grandes complications par une fixation atlanto-axoidienne postérieure au moyen d'un vissage réalisant un montage tridimensionnel. Pour l'incorporation de l'occipital dans la fusion et l'extension de l'arthrodèse jusqu'au rachis cervical inférieur, l'auteur présente une plaque en Y en Titane, dont l'efficacité est démontrée. Alors que la stabilisation peut être réalisée par un abord postérieur, la décompression quant-à elle est faite de préférence par discectomie ou vertébrectomie antérieure. Des résultats encourageants, avec notamment une récupération neurologique importante permettent de justifier une intervention précoce dans les cas d'instabilité cervicale d'origine rhumatoïde.
Summary
About 20% of patients with rheumatoid arthritis complain about neck problems based on instability and deformity. As a consequence, pain, myelopathy, and severe neurological deficit may occur. Results reported in the literature were not encouraging as regards surgical decompression and stabilization. However, new surgical techniques allow a more aggressive strategy towards the complex problem of the instable cervical spine in rheumatoid arthritis. The most frequent instability of C1/2 can be stabilized by a posterior atlantoaxial screw fixation, a three-dimensional multidirectional construct with few complications. For the inclusion of the occiput into the fusion and the extension of the fusion down to the lower cervical spine, a titanium Y-plate is presented as a successful implant. While through a posterior approach, stability may be achieved, decompression is preferably done by anterior diskectomy or vertebrectomy. Encouraging results with a significant recovery of neurological deficits justify an early intervention in cases of instability of the cervical spine in rheumatoid arthritis.
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References
Barbour JR (1971) Screw fixation in fracture of the odontoid process. South Aust Clin 5:20–29
Brattström H, Granholm L (1973) Atlanto-axial fusion in rheumatoid arthritis. Acta Orthop Scand 47:619–628
Brattström H, Granholm L (1973) Chirurgie der Halswirbelsäule bei Patienten mit rheumatoider Arthritis. Orthopäde 2: 118
Brattström H, Brandt L, Ljungren B (1987) Atlanto-axial dislocation in rheumatoid arthritis—signs and symptoms, radiographic pathology, operative techniques and results. In: Voth D, Glees P (eds) Diseases in the cranio-cervical junction. de Gruyter, Berlin, pp 262–268
Brooks AL (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg [Am] 60:279
Cantore GP, Ciapetta P, Delfini R, Mariottini A (1982) Experiences in the use of methylmetacylaten in the stabilization of the cervical spine and the craniocervical junction. Acta Neurochir (Wien) 66:140
Castaing J, Gouaze A, Plisson JL (1963) Technique de l'arthrodese cervico-occipitale par greffon visse dans l'occipital. Rev Chir Orthop 49:123–127
Clark CR, Goetz DD, Menezes AH (1989) Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg [Am] 71:381–391
Conaty JP, Morgans ES (1981) Cervical fusion in rheumatiod arthritis. J Bone Joint Surg [Am] 63:1218–1227
Conlon PW, Isdale IC, Rose BS (1966) Rheumatoid arthritis of the cervical spine. An analysis of 33 cases. Ann Rheum Dis 25: 120–126
Crockard HA (1988) Anterior approaches to lesions of the upper cervical spine. Clin Neurosurg 34:389–416
Crockard HA, Calder I, Ransford A (1990) One-stage transoral decompression and posterior fixation in rheumatoid atlanto-axial subluxation. J Bone Joint Surg [Br] 72:682–685
Davis FW, Markley HE (1951) Rheumatoid arthritis with death from medullary compression. Ann Med 35:451–454
Dunbar HS, Ray BS (1961) Chronic atlanto-axial dislocations with late neurologic manifestations. J Gynecol Obstet 113: 757–762
Dvorak J, Panjabi MM (1987) Functional anatomy of the alar ligaments. Spine 12:183–189
Dvorak J, Panjabi MM, Gerber M, Wichman W (1987) CT-functional diagnostics of the rotatory instability of upper cervical spine. Part 1. An experimental study on cadavers. Spine 12: 197–205
Dvorak J, Grob D, Baumgartner H, Gschwend N, Grauer W, Larsson S (1989) Functional evaluation of the spinal cord by magnetic resonance imaging in patients with rheumatoid arthritis and instability of upper cervical spine. Spine 14:1057–1064
Felic D, Clayton M, Leidholt J (1975) Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis. J Bone Joint Surg [Am] 57:349–354
Fielding JW, Cochran GVB, Lawnsing JF, Hohl M (1974) Tears of the transverse ligament of the atlas. J Bone Joint Surg [Am] 56:1683–1691
Fielding JW, Hawkins RJ, Ratzan SA (1976) Spine fusion for atlanto-axial instability. J Bone Joint Surg [Am] 58:400–407
Flint GA, Hockley AD, McMillan JJ, Thompson AG (1987) A new method of occipitocervical fusion using internal fixation. Neurosurgery 21:947–950
Foerster O (1927) Die Leitungsbahnen des Schmerzgefühls und die chirurgische Behandlung der Schmerzzustände. Urban und Schwarzenberg, Berlin
Gallie WE (1939) Fractures and dislocations of the cervical spine. J Bone Joint Surg [Am] 46:495–499
Garrod AE (1890) A treatise on rheumatism and rheumatoid arthritis. Griffin, London
Grellin RQ, MacCabe JJ, Hamilton EBD (1978) Severe subluxation of the cervical spine in rheumatoid arthritis. J Bone Joint Surg [Br] 52:244–251
Grob D (1992) Operative dorsale Stabilisierungen der oberen Halswirbelsäule und des craniocervicalen Ueberganges. Thesis, University of Zürich
Reference deleted
Grob D, Magerl F (1987) Operative Stabilisierung bei Frakturen von C1 und C2. Orthopäde 16:46–54
Grob D, Magerl F, Seemann P (1988) Operative atlantoaxiale Stabilisierung. Springer, Berlin Heidelberg New York
Grob D, Dvorak J, Gschwend N (1990) Die Chirurgie der subaxialen Halswirbelsäule bei chronischer Polyarthritis. ARO Klausurtagung, Interlaken
Grob D, Crisco J, Panjabi MM, Dvorak J (1991) Biomechnanical evaluation of four different posterior atlanto-axial fixation techniques. Spine 17:480–490
Grob D, Dvorak J, Gschwend N (1991) Posterior occipitocervical fusion. Spine 26:S17-S24
Grob D, Dvorak J, Panjabi MM, Hayek J (1991) Die dorsale atlanto-axiale Verschraubung. Ein Stabilitätstest in vitro und in vivo. Orthopäde 20:154–162
Grob D, Jeanneret B, Aebi M, Markwalder T (1991) Atlanto-axial fusion with transarticular screw fixation. J Bone Joint Surg [Br] 73:972–976
Grob D, Dvorak J, Antinnes JA (1993) Surgical management of the subaxial cervical spine (C3-T1). Eur Spine J 2:60–64
Gschwend N (1987) Die operative Behandlung der cervico-occipitalen Instabilitäten bei Polyarthritis. Akt Rheumatol 12: 120–125
Guyotat J, Perrin G, Pelissou I, Daher T, Bachour E (1987) Utilization du matériel de Cotrel Dubousset dans les instabilités C1/C2. Neurochirugie 33:236–238
Hadra BE (1891) Wiring of the spinous processes in Pott's disease. Trans Am Orthop Assoc 4:206–211
Hauge T (1958) So-called spontaneous cervical dislocations. Acta Chir Scand 5:232
Holmes JC, Hall JE (1978) Fusion for instability and potential instability of the cervical spine in children and adolescents. Orthop Clin North Am 9:923–943
Holness RO, Huestis WS, Howes WS, Langille RA (1984) Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Neurosurgery 14:318–322
Isdale I, Conlon P (1971) Atlantoaxial subluxation. A six year follwo-up report. Ann Rheum Dis 30:387–389
Itoh T, Tsuji H, Katoh Y, Yonezawa T, Kitagawa T (1988) Occipito-cervical fusion reinforced by Luque's segmental spinal instrumentation for rheumatoid disease. Spine 11:1234–1238
Kawaida H, Sakou T, Morizono Y, Yoshikuni N (1989) Magnetic resonance imaging of the upper cervical disorders in rheumatoid arthritis. Spine 14:1144–1148
Lane WE (1892) Fracture (dislocation) of the spine. Reduction, temporary recovery. Lancet II:661
Larsson S, Toolanen G (1986) Posterior fusion for atlantoaxial subluxations in rheumatoid arthritis. Spine 1:525–530
Lipson SJ (1984) Rheumatoid arthritis of the cervical spine. Clin Orthop 182:143–149
Lipson S (1992) Rheumatoid disease of the cervical spine: surgical treatment. In: Camins M, O'Leary P (ed) Disorders of the cervical spine. Williams and Wilkins, Baltimore, pp 565–577
Magerl F, Seemann P (1986) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (ed) Cervical spine. Springer, Berlin Heidelberg New York, pp 322–327
Marks J, Sharp J (1981) Rheumatoid cervical myelopathy. Q J Med 50:307
Martel M (1977) Pathogenesis of cervical discovertebral destruction in rheumatoid arthritis. Arthritis Rheum 20: 1217–1225
Martel W, Abell MR (1963) Fatal atlanto-axial luxation in rheumatoid arthritis. Arthritis Rheum 6:224–231
McAfee P, Bohlmann H, Riley L, Robinson R, Southwick W, Nachlas N (1987) The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg [Am] 69: 1371–1383
McGregor M (1948) The significance of certain measurements of the skull in the diagnosis of basilar impression. Radiology 21-B:171–181
Meijers KA, Cats A, Kremer HPE, Luidendijk W, Onvlee GJ, Thomeer RTW (1984) Cervical myelopathy in rheumatoid arthritis. Clin Exp Rheumatol 2:239–245
Meikle J, Wilkinson M (1971) Rheumatoid involvement of the cervical spine. Ann Rheum Dis 30:154–161
Mikulowski P (1975) Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198:445–451
Mitsui H (1984) A new operation for atlanto-axial arthrodesis. J Bone Joint Surg [Br] 66:422
Mixter SJ, Osgood RB (1910) Traumatic lesions of the atlas and axis. Ann Surg 51:193–207
Panjabi M, Dvorak J, Crisco J, Oda T, Hilibrand A, Grob D (1991) Flexion, extension and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disorders 4:157–167
Panjabi M, Dvorak J, Crisco J, Oda T, Grob D (1991) Instabilität bei Verletzung der Ligamenta alaria. Orthopäde 20:112–120
Pellici P, Ranawat C, Tsairis P, Bryan W (1981) A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg [Am] 63:342–346
Privat JM (1988) Instabilités rhumatismales du rachis sous-occipital. Indications, et résultats de la plaque occipito-rachidienne monobloc. In: Privat J (ed) Ostheosynthèse rachidienne. Sauramps, Montpellier, pp 159–162
Rana NA (1989) Natural history of atlanto-axial subluxation in rheumatoid arthritis. Spine 14:1054–1056
Ransford A, Crockard H, Pozo J, Thomas N, Nelson I (1986) Craniocervical instability treated by a contoured loop fixation. J Bone Joint Surg [Br] 68:173–177
Redlund-Johnell I (1984) Posterior atlanto-axial dislocation in rheumatoid arthritis. Scand J Rheumatol 13:337–341
Roosen C, Grote W, Trauschel A (1983) Modern treatment of the symptomatic os odontoideum. Neurosurg Rev 6:229–232
Roy L, Gibson DA (1980) Cervical spine fusions in children. Clin Orthop 73:146–151
Roy-Camille R, Camus JB, Sailant GD, Conlon Y (1983) Luxation atloido-axodienne avec impression basilaire et signes medullaires due cours d'un rheumatisme inflammatoire chronique. Rev Chir Orthop 69:81–83
Schleich A, Albrecht HJ, Nusselt L, Weller E, Westerburg KW (1985) Zur Risikobeurteilung occipitocervicaler Dislokationen bei entzündlichen rheumatischen Krankheiten. Rheumatology 44:120–132
Schürmann K (1987) Operative stabilization of atlanto-axial dislocation combined with cervical compression (myelopahty) in rheumatoid arthritis. In: Voth D, Glees P (ed) Diseases in the cranio-cervical junction. de Gruyter, Berlin, pp 249–259
Sharp J, Purser DW (1961) Spontaneous atlanto-axial dislocation in ankylosing spondylitis and rheumatoid arthritis. Ann Rheum Dis 20:47–77
Sharp J, Purser J, Lawrence J (1958) Rheumatoid arthritis of the cervical spine in adults. Ann Rheum Dis 17:303–313
Smith P, Benn R, Sharp J (1972) Natural history of rheumatoid cervical luxations. Ann Rheum Dis 31:431–442
Spence KF, Decker S, Sell KW (1970) Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg [Am] 52:543–549
Steiger U, Gschwend N (1987) Surgical treatment for instability in craniocervical bones and their joints in rheumatoid arthritis. In: Voth D, Glees P (ed) Disease in the cranio-cervical junction. de Gruyter, Berlin, pp 241–248
Stratford J (1957) Myelopathy caused by atlanto-axial dislocation. Neurosurgery 14:97–104
Theiler R, Grob D, Dvorak J, Janssen B, Baumgartner H (1992) Schmerzlinderung durch transartikuläre atlanto-axiale Verschraubung bei Patienten mit chronischer Polyarthritis. Z Rheumatol 51:222–228
Waida NH (1967) Myelopathy complicating congenital atlanto-axial dislocation. Brain 90:449–472
Weissmann BN, Aliabadi P, Weinfield MS, Thomas WH, Sosman JL (1982) Prognositc features of atlanto-axial subluxation in rheumatoid arthritis patients. Radiology 144:745–751
Wertheim SB, Bohlmann HH (1987) Occipito-cervical fusion. J Bone Joint Surg [Am] 69:833–836
Whaley K, Dick WC (1986) Fatal subaxial dislocation of the cervical spine in rheumatoid arthritis. Br Med J 2:31
White AA, Panjabi MM (1990) Clincal biomechanics of the spine. Lippincott, Philadelphia
Zoma A, Sturrock RD, Fischer WD, Freeman PA, Hamblen DL (1987) Surgical stabilization of the rheumatoid cervical spine. A review of indications and results. J Bone Joint Surg [Br] 69:8–12
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Grob, D. Principles of surgical treatment of the cervical spine in rheumatoid arthritis. Eur Spine J 2, 180–190 (1993). https://doi.org/10.1007/BF00299444
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DOI: https://doi.org/10.1007/BF00299444
Mots-clés
- Rachis cervical
- Arthrite rhumatoïde
- Traitement chirurgical
- Indication chirurgicale
- Techniques opératoires