Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Neurosurgery. 2010 Mar;66(3 Suppl):83-95. doi: 10.1227/01.NEU.0000365854.13997.B0.
Rheumatoid arthritis (RA) is the most common inflammatory disease involving the spine. It has a predilection for involving the craniocervical spine. Despite widespread involvement of the cervical spine with RA, few patients need surgery. The 3 major spinal manifestations of RA in the cervical spine are basilar invagination, atlantoaxial instability, and subaxial subluxations. Surgical management of RA involving the craniovertebral junction remains a challenge despite a decline in severe cases and an improvement in surgical techniques.
We conducted an exhaustive review of English-language publications discussing RA involving the craniovertebral junction. We paid special attention to publications detailing modern surgical management of these conditions. In addition, we outline our own surgical experience with such patients.
We discuss alternative surgical methods for treating basilar invagination, atlantoaxial instability, and concurrent subaxial subluxations. We detail our surgical technique for transoral odontoidectomy, occipital cervical fusion, and atlantoaxial fusion. We detail the use of spinal surgical navigation in both of these procedures.
Surgical management of RA remains a challenging field. There clearly has been a decrease in cases of mutilating RA involving the craniovertebral junction. Surgical techniques for managing these conditions have steadily improved.
类风湿关节炎（RA）是最常见的累及脊柱的炎症性疾病。它偏爱累及颅颈脊柱。尽管 RA 广泛累及颈椎，但很少有患者需要手术。RA 在颈椎的 3 大脊柱表现为颅底凹陷、寰枢椎不稳和下颈椎半脱位。尽管严重病例减少，手术技术改进，但涉及颅颈交界区的 RA 的手术治疗仍然是一个挑战。
我们对讨论涉及颅颈交界区的 RA 的英语文献进行了全面回顾。我们特别关注详细描述这些疾病的现代手术治疗的出版物。此外，我们概述了我们自己对这些患者的手术经验。
我们讨论了治疗颅底凹陷、寰枢椎不稳和并发下颈椎半脱位的替代手术方法。我们详细介绍了经口寰枢椎切除术、枕颈融合术和寰枢椎融合术的手术技术。我们详细介绍了在这两种手术中使用脊柱手术导航的情况。
RA 的手术治疗仍然是一个具有挑战性的领域。涉及颅颈交界区的致残性 RA 病例显然有所减少。管理这些疾病的手术技术稳步提高。
