Surgical correction of fixed cervicomedullary compression at the craniovertebral level in a patient in the late stage of rheumatoid arthritis (clinical observation and literature review)

This article reviews the literature and presents a clinical case of surgical correction of fixed cervicomedullary compression (FCC) in rheumatoid arthritis (RA) involving the craniovertebral region. To demonstrate the possibilities of decompression-stabilization surgery in the surgical rehabilitation of a patient with severe RA. The observation period was more than 11 years. At the first visit, the patient underwent a two-stage surgical correction in one operation: stage 1 – transoral decompression – resection of the dens and 2 / 3 of the C2 vertebral body; stage 2 – occipitocervical fixation C0-C3-C4-C5-C6. The surgical treatment allowed to completely restore the patient’s functional independence. Upon re-admission (after 11 years), the elements of the fixing structure were reinstalled. A clinical observation is presented that demonstrates the effect of FCC in the late stage of RA on the functional status of the patient, as well as the possibilities of two-stage reconstructive-stabilizing surgery. Two-stage surgical correction for FCC is a key point of surgical rehabilitation, ensuring the possibility of returning patients to functional independence.