Postoperative Regression of Retro-odontoid Pseudotumor After Atlantoaxial Posterior Fixation: 11 Years of Experience in Patients With Atlantoaxial Instability.

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Abstract

[Indexed for MEDLINE] 3. J Craniovertebr Junction Spine. 2015 Apr-Jun;6(2):60-4. doi: 10.4103/0974-8237.156044. The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction. Khanna R(1), Dlouhy BJ(2), Smith ZA(1), Lam SK(3), Koski TR(1), Dahdaleh NS(1). Author information: (1)Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States. (2)Department of Neurological Surgery, University of Iowa, Carver School of Medicine, Iowa City, Iowa, United States. (3)Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas, United States. OBJECTIVE: Rheumatoid arthritis (RA) is an inflammatory disease that affects the craniovertebral junction (CVJ). Patients may suffer from atlantoaxial instability (AAI) and basilar invagination (BI) with variable presentations ranging from pain to quadriparesis. Managing these patients is often challenging due to their chronic use of steroids, methotrexate, and biologics; which impedes bone and wound healing. We report our experience with the surgical management of these patients undergoing fusions at the CVJ. MATERIALS AND METHODS: We conducted a retrospective study identifying all patients with the diagnosis of RA who underwent spinal fusions at our institution over the past 11 years. A total of 205 patients were identified amongst which 18 patients (8.8%) who underwent 20 fusions involving the CVJ. Demographic, clinical, and radiographic data were analyzed. RESULTS: Five patients had AAI and 13 patients had BI. Two patients with C1-2 fusions underwent reoperation: One for pseudoarthrosis and one for BI. The average preoperative Nurick was 1.4 and improved to 0.5 postoperatively (P < 0.001). After conducting analyses stratified by dichotomous preoperative variables, the presence of steroids, methotrexate, biologics, and prednisone dosage less than 7.5 mg did not affect outcomes. Prednisone dosages ≥7.5 mg had significantly smaller improvements in Nurick score compared to patients not on steroids or on prednisone dosages