Cervical Myelopathy Secondary to Bilateral Atlantoaxial Pseudoarticulations in Rheumatoid Arthritis: A Case Report.

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-03-28 DOI:10.14444/8735

Pragadesh Natarajan, Vignaraja Thirunavukarasu, Yingda Li

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引用次数: 0

Abstract

Background: Cervical myelopathy caused by pseudarthroses is rare, with the exact pathophysiology of its occurrence unclear and reports scarce. To the best of our knowledge, only a few cases have been reported so far. We present a case of cervical myelopathy secondary to bilateral pseudoarticulations in rheumatoid arthritis and discuss possible pathomechanisms with reference to previously published reports.

Case presentation: A 61-year-old woman with rheumatoid arthritis and previous C1 to C2 laminectomy suffered from cervical myelopathy. On preoperative imaging as well as surgical exploration, large osteophytes from bilateral pseudoarticulations between the posterior arches of the atlas and axis were seen to be causing severe compression of the spinal cord.

Case management: Posterior instrumented C1 to C2 fusion with patient-specific pedicle screws and surgical planning was performed. The patient had significant clinical improvement after fusion.

Conclusions: Ligamentous laxity in rheumatoid arthritis can lead to the development of pseudoarticulations, with dynamic forces of neck motion causing osteophytic bony spurs and cord compression. Posterior decompression and fusion was effective in this case of bilateral pseudoarticulations, which produced a posterolateral or "lateral recess" pattern of cord compression refractory to previous central decompression alone.

Level of evidence: 5:

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类风湿性关节炎继发于双侧寰枢假关节的颈椎病1例报告。

背景：假性关节引起的颈脊髓病是罕见的，其发生的确切病理生理尚不清楚，报道很少。据我们所知，到目前为止只报告了几例。我们报告一例继发于双侧假关节的类风湿性关节炎颈脊髓病，并参考先前发表的报道讨论可能的病理机制。病例介绍：一名61岁女性，类风湿关节炎，既往C1至C2椎板切除术，颈椎脊髓病。术前影像学和手术探查显示，寰椎后弓和椎轴之间的双侧假关节产生的大骨赘导致脊髓严重受压。病例处理：后路固定C1到C2融合与患者特定的椎弓根螺钉和手术计划。患者在融合后有明显的临床改善。结论：类风湿关节炎的韧带松弛可导致假关节的发展，颈部运动的动力导致骨赘骨刺和脊髓压迫。对于双侧假关节，后路减压和融合是有效的，该病例产生后外侧或“外侧隐窝”型脊髓压迫，先前单独的中央减压难以治愈。证据等级：5；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.