Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

BMC Surgery

In-Suk Bae¹  Jae Min Kim²  Myung-Hoon Han²  Yu Deok Won²  Je Il Ryu²  Jin Hwan Cheong²  Byeong Jin Ha²  Koang-Hum Bak³  Hyoung-Joon Chun³ 

[1] Department of Neurosurgery, Eulji University Eulji Hospital, 68, Hangeulbiseok-ro, Nowon-gu, 01830, Seoul, Republic of Korea;Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, 11923, Guri, Gyeonggi-do, Republic of Korea;Department of Neurosurgery, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, 04763, Seoul, Republic of Korea;

关键词: Atlantoaxial fusion;    Atlantoaxial instability;    Rheumatoid arthritis;    Atlantodental interval;    T1 slope;   

DOI  :  10.1186/s12893-020-00900-x

来源: Springer

【 摘 要 】

BackgroundAtlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA).MethodsWe retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2–C7 angle, were measured before and after surgery.ResultsThe various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34–15.73; p = 0.015).ConclusionWe found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

【 授权许可】

CC BY