Long-segment Spontaneous Cervical Arthrodesis in Juvenile Rheumatoid Arthritis

Abstract

Objectives: To describe the first case of long-segment spontaneous fusion of the cervical spine in juvenile rheumatoid art- hritis and the major pitfalls of its treatment. Materials and Methods: A 27-year-old female with juvenile rheumatoid arthritis presented with two-month duration of posterior neck pain and progressive weakness. Imaging studies showed spontaneous apophyseal joint fusion from occi- pital condyle to C6 and instability at C6/7 level. During operation, endotracheal intubation was not feasible due to stiff neck and the authors should select the way of tracheostomy. Moreover, severe osteoporosis restricted surgical option. At finally, the patient was approached posteriorly with interspinous process wiring with titanium-braded cable and integrated bone graft was performed at C6/7 level. Results: Fortunately, no postoperative complication were noted. While over 6 months of follow-up, pathologic reflexes disappeared and activities of daily living improved. Follow up computed tomography showed well-established bone fusion. Conclusion: It is suggested that spontaneous long-segment cervical arthrodesis is related with severity and rapid pro- gression of the disease, which seems to be a late manifestation of cervical involvement.