Department of Neurosurgery, Medical School, University of Ioannina, School of Medicine, Ioannina, Greece.
Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece.
Rheumatol Int. 2023 Feb;43(2):195-208. doi: 10.1007/s00296-022-05239-5. Epub 2022 Nov 15.
The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reported in 0-13% of cases. When it comes to surgical outcomes, Atlanto-axial joint (AAJ) fusion success rates ranged from 45.16 to 100% of cases. Furthermore, the incidence of postoperative subluxation ranged from 0 to 77.7%. With regards to AADI it is evident that its value decreased in all studies. Furthermore, an improvement in Ranawat classification was variable between studies with a report improvement frequency by at least one class ranging from 0 to 54.5%. In conclusion, through careful radiographic and clinical evaluation, cervical spine involvement in patients with RA can be detected. Surgery is a valuable option for these patients and can lead to improvement in their symptoms.
本系统评价的目的是描述类风湿关节炎颈椎的诊断评估，以更好地了解手术干预的适应证和选择。我们对 Pub-med、Embase 和 Scopus 数据库进行了文献回顾。在实施具体的纳入和排除标准后，确定了所有符合条件的文章。共有 1878 例类风湿关节炎（RA）患者接受了颈椎受累的平片评估。在平片上，寰枢关节半脱位（AAS）的范围为 16.4%至 95.7%，而下颈椎半脱位的范围为 10%至 43.6%。在中立位和屈曲位，前寰齿间距（AADI）分别为 2.5mm 和 4.61mm，而后寰齿间距（PADI）分别为 20.4mm 和 24.92mm。660 例 RA 患者接受了 MRI 检查。滑膜增生的诊断范围为 13.33%至 85.36%，而脊髓压迫的报告比例为 0%至 13%。就手术结果而言，寰枢关节（AAJ）融合成功率为 45.16%至 100%。此外，术后半脱位的发生率为 0%至 77.7%。关于 AADI，所有研究均表明其值降低。此外，研究之间 Ranawat 分类的改善情况各不相同，至少提高一个等级的报告频率为 0%至 54.5%。总之，通过仔细的影像学和临床评估，可以发现 RA 患者的颈椎受累。手术是这些患者的一个有价值的选择，可以改善他们的症状。
