TY - JOUR
T1 - Regression of an atlantoaxial rheumatoid pannus following posterior instrumented fusion
AU - Bydon, Mohamad
AU - Macki, Mohamed
AU - Qadi, Mohamud
AU - De La Garza-Ramos, Rafael
AU - Kosztowski, Thomas A.
AU - Sciubba, Daniel M.
AU - Wolinsky, Jean Paul
AU - Witham, Timothy F.
AU - Gokaslan, Ziya L.
AU - Bydon, Ali
N1 - Funding Information:
Ali Bydon is the recipient of a research grant from Depuy Spine . He serves on the clinical advisory board of MedImmune, LLC.
Funding Information:
Ziya Gokaslan is the recipient of research grants from Depuy Spine, AO Spine North America , Medtronic , NREF , Integra Life Sciences , and K2M . He receives fellowship support from AO Spine North America. He holds stock in Spinal Kinetics and US Spine.
Funding Information:
Timothy Witham is the recipient of a research grant from Eli Lilly & Co and The Gordon & Marilyn Macklin Foundation .
Funding Information:
Daniel Sciubba is the recipient of a research grant from Depuy Spine. He has consulting relationships with Medtronic, Nuvasiv, Globus, and Depuy.
Publisher Copyright:
© 2015 Elsevier B.V. All rights reserved.
PY - 2015/6/29
Y1 - 2015/6/29
N2 - Objective Rheumatoid patients may develop a retrodental lesion (atlantoaxial rheumatoid pannus) that may cause cervical instability and/or neurological compromise. The objective is to characterize clinical and radiographic outcomes after posterior instrumented fusion for atlantoaxial rheumatoid pannus. Methods We retrospectively reviewed all patients who underwent posterior fusions for an atlantoaxial rheumatoid pannus at a single institution. Both preoperative and postoperative imaging was available for all patients. Anterior or circumferential operations, non-atlantoaxial panni, or prior C1-C2 operations were excluded. Primary outcome measures included Nurick score, Ranawat score (neurologic status in patients with rheumatoid arthritis), pannus regression, and reoperation. Pannus volume was determined with axial and sagittal views on both preoperative and postoperative radiological images. Results Thirty patients surgically managed for an atlantoaxial rheumatoid pannus were followed for a mean of 24.43 months. Nine patients underwent posterior instrumented fusion alone, while 21 patients underwent posterior decompression and instrumented fusion. Following a posterior instrumented fusion in all 30 patients, the pannus statistically significantly regressed by 44.44%, from a mean volume of 1.26 cm3 to 0.70 cm3 (p < 0.001), over 8.02 months. The Nurick score significantly improved from 2.40 to 0.60 (p < 0.001), but the marginal improvement of 0.20 in the Ranawat score did not reach significance (p = 0.312). Six patients (20%) required reoperations over a mean of 13.18 months. Reoperations were indicated for C1 instrumentation failure in four patients and pseudoarthrosis in two patients. Conclusion Following posterior instrumented fusion, the pannus radiographically regressed by 44.44% over a mean of 8.02 months, and patients clinically improved per the Nurick score. The Ranawat score did not improve, and 20% of patients required reoperation over a mean of 13.18 months. The annualized reoperation rate was approximately 13.62%.
AB - Objective Rheumatoid patients may develop a retrodental lesion (atlantoaxial rheumatoid pannus) that may cause cervical instability and/or neurological compromise. The objective is to characterize clinical and radiographic outcomes after posterior instrumented fusion for atlantoaxial rheumatoid pannus. Methods We retrospectively reviewed all patients who underwent posterior fusions for an atlantoaxial rheumatoid pannus at a single institution. Both preoperative and postoperative imaging was available for all patients. Anterior or circumferential operations, non-atlantoaxial panni, or prior C1-C2 operations were excluded. Primary outcome measures included Nurick score, Ranawat score (neurologic status in patients with rheumatoid arthritis), pannus regression, and reoperation. Pannus volume was determined with axial and sagittal views on both preoperative and postoperative radiological images. Results Thirty patients surgically managed for an atlantoaxial rheumatoid pannus were followed for a mean of 24.43 months. Nine patients underwent posterior instrumented fusion alone, while 21 patients underwent posterior decompression and instrumented fusion. Following a posterior instrumented fusion in all 30 patients, the pannus statistically significantly regressed by 44.44%, from a mean volume of 1.26 cm3 to 0.70 cm3 (p < 0.001), over 8.02 months. The Nurick score significantly improved from 2.40 to 0.60 (p < 0.001), but the marginal improvement of 0.20 in the Ranawat score did not reach significance (p = 0.312). Six patients (20%) required reoperations over a mean of 13.18 months. Reoperations were indicated for C1 instrumentation failure in four patients and pseudoarthrosis in two patients. Conclusion Following posterior instrumented fusion, the pannus radiographically regressed by 44.44% over a mean of 8.02 months, and patients clinically improved per the Nurick score. The Ranawat score did not improve, and 20% of patients required reoperation over a mean of 13.18 months. The annualized reoperation rate was approximately 13.62%.
KW - Atlantoaxial
KW - Fusion
KW - Pannus
KW - Posterior
KW - Retrodental
KW - Rheumatoid
UR - http://www.scopus.com/inward/record.url?scp=84933055981&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84933055981&partnerID=8YFLogxK
U2 - 10.1016/j.clineuro.2015.06.010
DO - 10.1016/j.clineuro.2015.06.010
M3 - Article
C2 - 26125675
AN - SCOPUS:84933055981
SN - 0303-8467
VL - 137
SP - 28
EP - 33
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
ER -