Mise au point en chirurgie des maladies inflammatoires du rachis cervical supérieur

Abstract

The upper cervical spine (occiput-atlas-axis) is an osteo-ligamentary system that may be subject to specific lesions in chronic inflammatory diseases of the spine. Rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, and articular chondrocalcinosis can lead to destruction or calcification of the osteo-ligamentary elements and result in situations of biomechanical instability and/or compression of the neuraxis. The purpose of this article is to summarize the current indications and to present the most recent considerations regarding surgical management. It should be noted that the indications for inflammatory diseases of the upper cervical spine tend to decrease. The surgical principles of decompression/stabilization remain broadly classical, adapted to the anatomical situation. For decompression, a technical innovation is the anterior approach by nasal endoscopy, but it is not very widespread. For stabilization, the most recent work favors the shortest fixtures and shows the interest for the concept of sagittal spinal balance at the cervical level.