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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 7, 955-958.
doi: 10.1302/0301-620X.87B7.15862  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Results after 24 years of prophylactic surgery for rheumatoid atlantoaxial subluxation

N. Tanaka, MD, Orthopaedic Surgeon1; H. Sakahashi, MD, Orthopaedic Surgeon1; K. Hirose, MD, Orthopaedic Surgeon1; T. Ishima, MD, Orthopaedic Surgeon1; H. Takahashi, MD, Consultant in Internal Medicine2; and S. Ishii, MD, Orthopaedic Surgeon3

1 Sapporo Gorinbashi Orthopaedic Hospital in Gorinbashi Health Care Facilities and Hospitals, 2-1 Kawazoe, Minami-ku, Sapporo, Hokkaido 005-0802, Japan.
2 Department of Internal Medicine
3 Department of Orthopaedic Surgery, School of Medicine Sapporo Medical University, 291 South 1 West 16, Cyuou-ku, Sapporo, Hokkaido 060-8556, Japan.

Correspondence should be sent to Dr N. Tanaka; e-mail: nobuyuki.tanaka{at}ryumachi-jp.com

We evaluated the use of surgical stabilisation for atlantoaxial subluxation after a follow-up of 24 years in 50 rheumatoid patients who had some degree of pain but no major neurological deficit.

The mortality of patients treated by atlantoaxial fusion was significantly lower than for those who received conservative treatment. The deaths resulted from infection or comorbid conditions. The significantly high relative risks of mortality from conservative treatment compared with surgical treatment were mutilating disease and susceptible factors on both of the HLA-DRB1 alleles. Relief from pain and neurological and functional recovery were better, and the radiological degree of atlantoaxial translocation was less in those who were surgically treated compared with those who were not. Two patients had superficial local infections after surgery. We conclude that prophylactic atlantoaxial fusion is better than conservative treatment in these patients.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General