Cervical spine fusion in rheumatoid arthritis.

Spinal fusion for deformity of the cervical spine was done in thirty-three patients with rheumatoid arthritis. The average follow-up was three years. The deformities present were atlano-axial subluxation, superior migration of the odontoid process into the foramen magnum, and subaxial subluxation of the vertebral bodies. We devised a classification of the pain and the neural involvement in these patients and a new method of measuring superior migration. The surgical procedures for treating instability, intractable pain, or neural involvement, or a combination of the three, were: (1) a Gallie fusion of the first and second cervical vertebrae for atlanto-axial subluxation, (2) a fusion of the occiput and the second cervical vertebra for superior migration of the odontoid process, and (3) a posterior fusion for subaxial subluxation. The occiput was included in the fusion if superior migration of the odontoid process was demonstrated. The results show that four of five patients who had an anterior fusion had no improvement. Twenty-five patients had posterior fusion; in seventeen the condition was improved, in five there was improvement, and in three the condition was worse. Of nineteen patients with neural involvement, the condition was improved in eight, it was unchanged in seven, and it was made worse in two. There were three postoperative deaths and six additional unrelated deaths within two years of surgery. There were five pseudarthroses.

Coexistence of cervical and lumbar disc disease.

A retrospective analysis of 200 patients requiring cervical disc surgery was performed to determine the frequency of coexistent lumbar disc or spine abnormalities. The duration of follow-up ranged from 5 to 25 years, averaging 14 years. Sixty percent were women and 40% were men, their ages ranging from 25-73 years. Antecedent motor vehicle injury had occurred in 49 cases and work injury to the spine in 23. Sixty-four percent had no history of prior back injury. It was found that over 31% had undergone lumbar disc surgery, and a high number of patients demonstrated abnormal lumbar radiographs or myelograms, including 78 with bulging discs, 100 with major root defects, 78 with minor root defects, 8 with spinal stenosis, and 7 with spondylolisthesis. Myelograms were normal in 22 cases. The sites of lumbar abnormalities included L4-5 (110), L5-S1 (90), and multilevel (8). There was a higher incidence of lumbar disc abnormalities associated with multilevel cervical spondylosis. There also was a relationship between residual symptoms and myelographic abnormalities. Two studies in the authors' institution suggest an autoimmune basis for the frequent coexistence of cervical and lumbar disc disease, namely the demonstration of antigenic properties in the nucleus pulposus and high serum immunoglobulins.

Lumbar adhesive arachnoiditis. Etiologic and pathologic aspects.

The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic evidence of arachnoiditis ossificans in 3 patients and arachnoiditis calcificans in 1 patient.

Traumatic partial arrest of tibial physis.

Two children with premature partial arrest of the tibial physis, one proximal and the other distal, were treated by resection of the bony bar and by the Langenskiold method of interposition of fat. In one child the arrest was the result of an open fracture and bony loss of the upper tibia. In the other child the arrest was caused by a Salter IV fracture. Preservation of the fat implant 20 months after operation was observed histologically. Correction of the deformity was accomplished in one case but not in the other.

Cauda equina syndrome complicating ankylosing spondylitis: MR features.

A case of cauda equina syndrome complicating long standing ankylosing spondylitis is presented. Bony erosions were demonstrated on CT. Magnetic resonance showed arachnoid diverticula filling the erosions. Magnetic resonance obviated the need for intrathecal contrast medium injection.

Monostotic Paget's disease of the spine.

Mnostotic Paget's disease in the spine often presents with an atypical clinical and radiographic picture. Paget's disease should be included in the differential diagnosis of any sclerotic lesion of the spine. Although uncommon, the disease occurs even in young adults, and may present a diagnostic problem.

Auto-immunological basis of disk degeneration.

Ninety-four subjects were divided into 5 groups according to symptoms and radiologic findings to devise a test for immunoglobin levels and lymphocyte microstimulation. Cellular immunity to disk antigens can be demonstrated in disk degeneration which may be primary or secondary. The serum level of IgM, irrespective of the age of the individual was significantly higher in patients with backache than asymptomatic patients.