1. Interesting Case* Surgery in Rheumatoid Cervical Spine with Spondylotic Myelopathy
Manoj Krishna,Spine Surgeon.
Shailesh Hadgaonkar,Spine Fellow.
Spinal Unit, University Hospital North Tees,
Stockton OnTees

2. Clinical Story 62 yr/m,came with Imbalance Neck pain-on & off
Difficulty in performing fine functions
He was diagnosed c/o RA

3. Rhematoid Features Minor Enthesophytes-Patella ErosiveArthropathy-
Severe Changes
ErosiveArthropathy-
Radiocarpel,Intercarpel,Metacarpo
phalyngeal jts
Minor Enthesophytes-Patella

4. Pre Op – Severe Spondylosis
Lateral:
Ap:

5. MRI- multi-level compression of the spinal cord
Sag T2
Multilevel affection

6. MRI – T1 Sag & Axial Image Cervical Cord Compression
Multilevel Spinal Canal Stenosis
Cervical Cord Compression

7. Intra-Op ,C-Arm Pic Complex anatomy Spondylotic Spine
OPERATION- POSTERIOR DECOMPRESSION AND LATERAL MASS FIXATION

8. Immediate Post op X ray-Day 1
Lateral:
AP:

9. “2 weeks post op” Good Decompression + Lat
“2 weeks post op” Good Decompression + Lat. Mass Fixation- PATIENT REPORTED SIGNIFICANT IMPROVEMENT IN SYMPTOMS
Lateral:
Ap :

10. LEARNING POINTS
Cervical Myelopathy is common in patients with Rheumatoid Arthritis
Posterior decompression and stabilization offers a good alternative to anterior surgery