Efficacy and Durability of the Titanium Mesh Cage Spacer Combined With Transarticular Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2009-10, Vol.34 (22), p.2384-2388
• Main Authors: CHUN, Hyoung-Joon, SEONG HOON OH, YI, Hyeong-Joong, KO, Yong
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Arthritis, Rheumatoid - complications; Atlanto-Axial Joint - diagnostic imaging; Atlanto-Axial Joint - pathology; Atlanto-Axial Joint - surgery; Axis, Cervical Vertebra - diagnostic imaging; Axis, Cervical Vertebra - pathology; Axis, Cervical Vertebra - surgery; Biological and medical sciences; Bone Screws - adverse effects; Bone Screws - statistics & numerical data; Cerebrospinal fluid. Meninges. Spinal cord; Cervical Atlas - diagnostic imaging; Cervical Atlas - pathology; Cervical Atlas - surgery; Equipment Failure; Equipment Failure Analysis; Female; Humans; Internal Fixators - adverse effects; Internal Fixators - statistics & numerical data; Joint Instability - etiology; Joint Instability - pathology; Joint Instability - surgery; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system (semeiology, syndromes); Neurology; Outcome Assessment (Health Care); Postoperative Complications - etiology; Postoperative Complications - physiopathology; Postoperative Complications - prevention & control; Radiography; Retrospective Studies; Spinal Fusion - adverse effects; Spinal Fusion - instrumentation; Spinal Fusion - methods; Titanium - adverse effects; Titanium - therapeutic use; Treatment Outcome; Young Adult; Zygapophyseal Joint - pathology; Zygapophyseal Joint - surgery
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181b04f1d

A retrospective study. This retrospective investigation was conducted to determine efficacy and endurance of titanium mesh cage as a strut for interlaminar wiring by comparing with autologous iliac bone graft (AIBG). For patients with atlantoaxial instability (AAI), allograft bone was harvested on an interlaminar mesh cage and transarticular fixation (TAF) was performed. There have been few studies about atlantoaxial fusion rate and advantages for titanium mesh cage from comparison with AIBG in rheumatoid arthritis (RA) patients. Between January 1998 and October 2007, 55 RA patients were surgically treated for AAI. Among them, 34 patients who underwent surgical treatment with TAF and interlaminar wiring using mesh cage packed with allograft, enrolled in this study (group I). For evaluation of bone fusion about mesh cage group, 21 RA patients who underwent TAF and interlaminar wiring with AIBG were also selected (group II). In both groups, radiologic evidence of bone fusion was assessed with measuring atlantodental interval. Patients were strongly encouraged to mobilize by postoperative 1 day with external cervical bracing. The mean follow-up period was 12.3 months (6-36 months). Overall, bone fusion was achieved in 33 patients (97%) in group I. And, this was comparable with 100% of group II. There was no statistical difference in bone fusion rate. During the study period, there were 2 instrument-related complications of screw malposition and cable loosening. The results of this study in which mesh cage was used as an interlaminar spacer, showed immediate rigid fixation and successful bone union. We also could prevent donor site morbidities frequently seen in patients with surgical treatment for AAI.