Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
Neurosurg Rev. 2021 Aug;44(4):1957-1965. doi: 10.1007/s10143-020-01412-1. Epub 2020 Oct 10.
Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.
类风湿关节炎（RA）是一种进行性自身免疫性炎症性疾病，影响人群中的 1%，女性是男性的三倍。多达 86%的 RA 患者存在颈椎受累。颈椎滑膜炎症导致不稳定和损伤，包括寰枢关节半脱位、齿状突后滑膜增生、颅底下沉和下颈椎半脱位。虽然许多颈椎受累的患者无症状，但有症状的患者常因炎症和压迫脑干、颅神经、椎动脉和脊髓引起的其他继发性症状而出现非特异性症状。放射学是最常用的影像学检查方式，而 MRI 和 CT 则用于评估神经结构受累和手术规划。目前存在多种分类系统。早期诊断和治疗颈椎受累至关重要。当患者因颈椎受累导致生物力学不稳定和/或神经功能缺损而出现症状时，需要进行手术治疗。寰枢关节不稳定通过寰枢关节融合治疗，齿状突后滑膜增生并压迫神经结构时通过后路减压和寰枢关节融合或枕颈融合治疗。颅底下沉可通过前路减压和后路融合或仅后路方法治疗。下颈椎半脱位通过环形融合或后路单纯减压融合治疗。寰枢关节不稳定的患者具有更好的功能和神经结局。RA 患者的并发症发生率和翻修手术需求高于一般脊柱手术患者。
