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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La inestabilidad en los segmentos superiores de la columna cervical es un hecho com&#250;n en pacientes con artritis reumatoide &#40;A&#46;R&#41; de larga evoluci&#243;n&#46; Presentamos 8 pacientes con historia de A&#46;R grave e inestabilidad cervical que han sido tratados con artrodesis posterior&#46; En el momento del tratamiento la duraci&#243;n media de la A&#46;R era de 16&#46;6 a&#241;os y la de los s&#237;ntomas 5&#46;7 meses&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En todos los pacientes se evidenci&#243; subluxaci&#243;n atlantoaxial reducible&#44; uno de ellos presentaba adem&#225;s impresi&#243;n basilar&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Las indicaciones quir&#250;rgicas fueron deterioro neurol&#243;gico progresivo en seis pacientes y subluxaci&#243;n atlantoaxial mayor de 8<span class="elsevierStyleHsp" style=""></span>mm sin signos de compresi&#243;n medular en dos pacientes&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En cinco casos se realiz&#243; artrodesis atlanto-axial&#59; en uno fijaci&#243;n atlanto-C3 y en dos la uni&#243;n fue occipitocervical&#46; En un paciente se realiz&#243; adem&#225;s una odontoidectom&#237;a transoral&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El seguimiento medio tras la cirug&#237;a fue de 21&#46;1 meses &#40;m&#237;nimo 5 meses y m&#225;ximo 43 meses&#41;&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En todos los pacientes mejoraron las parestesias y el dolor cervical&#46; De los seis pacientes que presentaban s&#237;ntomas neurol&#243;gicos en el preoperatorio&#44; cinco &#40;83&#46;3&#37;&#41; mejoraron un grado despu&#233;s de la cirug&#237;a seg&#250;n la clasificaci&#243;n de Ranawat et al&#46; En siete casos &#40;87&#46;5&#37;&#41; se produjo asimilaci&#243;n del injerto y en uno se constat&#243; la reabsorci&#243;n de &#233;ste&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre las complicaciones encontramos dos casos de infecci&#243;n de herida quir&#250;rgica&#59; en un paciente se produjo la rotura de los alambres&#46; La mortalidad quir&#250;rgica fue nula&#46;</p>"
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        "resumen" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Upper cervical instability is a relatively common problem in patients with long-standing rheumatoid disease&#46; Eight patients with severe rheumatoid arthritis &#40;R&#46;A&#46;&#41; and cervical instability treated with a posterior arthrodesis are presented&#46; At the time of treatment&#44; the mean duration of the R&#46;A&#46; was 16&#46;6 years and the mean duration of symptoms was 5&#46;7 months&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">All patients had reducible atlanto-axial subluxation&#44; one of them with penetration of the dens&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Indications for operative therapy included progressive neurological impairment in six patients and mobile atlantoaxial subluxation greater than 8<span class="elsevierStyleHsp" style=""></span>mm without signs or symptoms of cord compression in two patients&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The surgical treatment was an atlanto-axial arthrodesis in five patients&#44; an atlanto-C3 fusion in one patient and an occipital-cervical arthrodesis in two cases&#46; One patient was in addition submitted to a transoral odontoidectomy&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The average follow-up was 21&#46;1 months &#40;range&#44; five to forty-three months&#41;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Pain and paresthesias were relieved in all patients&#46; Of the six patients with neurologic symptoms&#44; five &#40;83&#46;3&#37;&#41; improved one class level after surgery following the neurological classification of Ranawat et al&#46; Seven &#40;87&#46;5&#37;&#41; of the patients had osseous union&#44; and one had a non-union&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Complications included a superficial wound infection in two cases and a broken wire in one&#46; No patient died postoperatively&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Pardo&#44; S&#46;&#59; Molet&#44; J&#46;&#59; Fern&#225;ndez Villa&#44; J&#46;M&#46;&#59; Tresserras&#44; P&#46;&#59; Oliver&#44; B&#46;&#59; Par&#233;s&#44; P&#46;&#59; Bartumeus&#44; F&#46;&#58; Artrodesis por v&#237;a posterior en las luxaciones cervicales altas en pacientes con artritis reumatoide&#46; Neurocirug&#237;a 1998&#59; 9&#58; 209&#8211;219&#46;</p>"
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Vol. 9. Núm. 3.
Páginas 209-219 (enero 1998)
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Vol. 9. Núm. 3.
Páginas 209-219 (enero 1998)
Artrodesis por vía posterior en las luxaciones cervicales altas en pacientes con artritis reumatoide
Posterior arthrodesis of the unstable upper cervical spine in rheumatoid arthritis
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S. Pardo, J. Molet, J.M. Fernández Villa, P. Tresserras, B. Oliver, P. Parés, F. Bartumeus
Servicio de Neurocirugía. Hospital de la Santa Creu i Sant Pau. Universidad Autónoma de Barcelona
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Resumen

La inestabilidad en los segmentos superiores de la columna cervical es un hecho común en pacientes con artritis reumatoide (A.R) de larga evolución. Presentamos 8 pacientes con historia de A.R grave e inestabilidad cervical que han sido tratados con artrodesis posterior. En el momento del tratamiento la duración media de la A.R era de 16.6 años y la de los síntomas 5.7 meses.

En todos los pacientes se evidenció subluxación atlantoaxial reducible, uno de ellos presentaba además impresión basilar.

Las indicaciones quirúrgicas fueron deterioro neurológico progresivo en seis pacientes y subluxación atlantoaxial mayor de 8mm sin signos de compresión medular en dos pacientes.

En cinco casos se realizó artrodesis atlanto-axial; en uno fijación atlanto-C3 y en dos la unión fue occipitocervical. En un paciente se realizó además una odontoidectomía transoral.

El seguimiento medio tras la cirugía fue de 21.1 meses (mínimo 5 meses y máximo 43 meses).

En todos los pacientes mejoraron las parestesias y el dolor cervical. De los seis pacientes que presentaban síntomas neurológicos en el preoperatorio, cinco (83.3%) mejoraron un grado después de la cirugía según la clasificación de Ranawat et al. En siete casos (87.5%) se produjo asimilación del injerto y en uno se constató la reabsorción de éste.

Entre las complicaciones encontramos dos casos de infección de herida quirúrgica; en un paciente se produjo la rotura de los alambres. La mortalidad quirúrgica fue nula.

Palabras clave:
Artritis reumatoide
Subluxación atlantoaxial
Fijación columna
Columna cervical
Cirugía transoral
Summary

Upper cervical instability is a relatively common problem in patients with long-standing rheumatoid disease. Eight patients with severe rheumatoid arthritis (R.A.) and cervical instability treated with a posterior arthrodesis are presented. At the time of treatment, the mean duration of the R.A. was 16.6 years and the mean duration of symptoms was 5.7 months.

All patients had reducible atlanto-axial subluxation, one of them with penetration of the dens.

Indications for operative therapy included progressive neurological impairment in six patients and mobile atlantoaxial subluxation greater than 8mm without signs or symptoms of cord compression in two patients.

The surgical treatment was an atlanto-axial arthrodesis in five patients, an atlanto-C3 fusion in one patient and an occipital-cervical arthrodesis in two cases. One patient was in addition submitted to a transoral odontoidectomy.

The average follow-up was 21.1 months (range, five to forty-three months).

Pain and paresthesias were relieved in all patients. Of the six patients with neurologic symptoms, five (83.3%) improved one class level after surgery following the neurological classification of Ranawat et al. Seven (87.5%) of the patients had osseous union, and one had a non-union.

Complications included a superficial wound infection in two cases and a broken wire in one. No patient died postoperatively.

Key words:
Rheumatoid arthritis
Atlantoaxial subluxation
Spinal fusion
Cervical spine
Transoral surgery

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