Unit:
Κατεύθυνση Μεταβολικά Νοσήματα των ΟστώνLibrary of the School of Health Sciences
Author:
Zogakis Efstathios
Supervisors info:
Λυρίτης Γεώργιος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δοντά Ισμήνη-Νίκη, Καθηγήτρια, Ιατρική Σχολή,ΕΚΠΑ
Χρονόπουλος Ευστάθιος,Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Θεραπευτικές προσεγγίσεις ατλαντοαξονικής αστάθειας σε ασθενείς με ρευματοειδή αρθρίτιδα
Translated title:
Therapeutic approaches to atlantoaxial instability in patients with rheumatoid arthritis
Summary:
Rheumatoid arthritis is an inflammatory disease that commonly affects the cervical spine. These patients often suffer from atlantoaxial instability, which is characterized by excessive movement at the junction between the first and the second cervical vertebrae as a result of either a bony or ligamentous laxity. Symptoms of this disease may vary from pain to myelopathy and nerve palsies. Imaging modalities used for the diagnosis and screening of the atlantoaxial instability in rheumatoid patients are plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Each imaging method has its benefits and limitations. Until recently drug therapy included nonsteroidal anti-inflammatory drugs, corticosteroids and painkillers for these patients. Recently disease-modifying antirheumatic drugs (DMARDS) have replaced the former drugs and have achieved satisfactory results. If pharmacotherapy fails including persistent cervical pain and neurologic dysfunction along with abnormal imaging parameters, surgical intervention must take place. Goals of surgical intervention are atlantoaxial stabilization and spinal cord decompression. Surgical options for atlantoaxial instability include wiring techniques, atlantoaxial fusion with posterior instrumentation, c1 laminectomy and even transoral resection of dens. All these techniques offer a great variety of options in treating atlantoaxial instability but always the surgeon’s experience, the patient’s anatomy and the integrity of the bony structures should be taken into consideration.
Main subject category:
Health Sciences
Keywords:
Rheumatoid Arthritis, Atlantoaxial Instability, Atlantoaxial Subluxation, Cervical Myelopathy, Atlanto-dens Interval, Atlantoaxial Fusion
Number of references:
100
