Artikel
The dorsal transarticular spondylodesis C1/C2 (Magerl's procedure): a retrospective study of patients with atlanto-axial instability and rheumatoid arthritis
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Autoren
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J. Neumann
- ENDO-Klinik, Orthopädie, Hamburg
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J. Löhr
- Hamburg
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D. Grob
- Zürich
| Veröffentlicht: | 13. Juni 2005 |
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Gliederung
Text
Introduction
About 20% of patients with rheumatoid arthritis develop an atlanto-axial instability. A once established instability tends to proceed and sometimes may lead to a lifethreatenning condition. Until now the only therapy is surgical atlanto-axial stabilization. In a retrospective study the results of the dorsal transarticular spondylodesis at C1/C2 level are presented (Magerl´s procedure).
Patients and Method
At the Schulthess-Klinik in Zuerich 98 patients (75 female and 23 male) were treated between 1987 and 2000 for an atlanto-axial instability with the above mentioned procedure. The average age was 58.7 years. The mean postoperative follow-up was 7.1 years (maximum 14 years, minimum 3 months), consisting of a physical medical examination, x-rays and a questionary.
Results
The operation led to a significant decrease of neck-pain on the visualizid pain scale rating from zero to ten. Only 4% of the patients were unsatisfied with the operation´s result and only 6% would not undergo this procedure anew. Radiologically 93% of the patients showed a solid integration of the cortico-spongious bone. In ten cases a fracture of one or both screws was noticed, but only three patients showed a clinically significant instability resulting in a respondylodesis.
Discussion
The transarticular dorsal spondylodesis at C1/2 is a reliable method of neck-pain reduction and removal of the atlanto-axial instability for patients with rheumatoid arthritis. Taking into consideration the poor bone quality of polyarthritic patients, the fusion rate of the Magerl procedure is very satisfying.
