Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Spine
Abstract number: 26356
OCCIPITOCERVICAL FUSION FOR RHEUMATOID CERVICAL SPINE AT LEAST
OVER-10 YEAR AFTER SURGERY.
Jun MIZUTANI, Muneyoshi FUKUOKA, Nobuyuki SUZUKI, Osamu OGIKUBO,
Yoshimi HAYASHI, Takanobu OTSUKA
Nagoya City University, Nagoya (JAPAN)
Introduction: Few studies have reported the long-term outcomes of
occipitocervical/thoracic fusion for rheumatoid cervical spine. The purpose of this
study was to evaluate the outcome of occipitocervical/thoracic fusion at least over-10
year after surgery. Patients: Thirty-nine patients who had occipitocervical/thoracic
fusion between 1987 and 1998 were evaluated. The mean age at surgery was 61
years. Results: Twenty-seven patients died before the final follow-up. Mean survival
period of patients in class IIIB was 70.0 months and that for patients in non-IIIB was
109.7 months. The mean follow-up for surviving patients was 167. 2 months. Pain in
the occipital region and neck recovered well until final follow-up. Assessment at 1
year postoperatively revealed that all patients recovered and reported pain as grade
0 or 1. Until the final follow-up, the recovered pain grade was well maintained in all
but 3 patients. These patients had pseudoarthrosis or required revision surgery.
Good neurologic recovery in patients in Ranawat class IIIB was not observed.
Discussion: Some surgeons insist that prophylactic occipito-cervical/thoracic fixation
would be better. However, other surgeons advocate a minimal extent of fusion,
considering the invasiveness of the surgery and the patients’ relatively short life
expectancy. Our results showed surgery with a minimal extent of fusion maintained
satisfactory long-term clinical outcomes, although adjacent segment instability
occurred and required revision surgery in some patients. Rheumatoid arthritis is a
systemic inflammatory disease that affects multiple organs, so we should consider
tailor-made surgery based on each individual patient’s condition.
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