Rationale and design of The Delphi Trial – I(RCT)2: international randomized clinical trial of rheumatoid craniocervical treatment, an intervention-prognostic trial comparing 'early' surgery with conservative treatment [ISRCTN65076841] |
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Authors: | Jasper FC Wolfs Wilco C Peul Maarten Boers Maurits W van Tulder Ronald Brand Hans JC van Houwelingen Raph TWM Thomeer |
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Institution: | (1) Department of Neurosurgery, Leiden University Medical Center, The Netherlands;(2) Department of Epidemiology and Rheumatology, VU Medical Center Amsterdam, The Netherlands;(3) Institute for Research in Extramural Medicine (EMGO), VU Medical Center Amsterdam, The Netherlands;(4) Department of Biostatistics, Leiden University Medical Center, The Netherlands |
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Abstract: | Background Rheumatoid arthritis is a chronic inflammatory disease, which affects 1% of the population. Hands and feet are most commonly
involved followed by the cervical spine. The spinal column consists of vertebrae stabilized by an intricate network of ligaments.
Especially in the upper cervical spine, rheumatoid arthritis can cause degeneration of these ligaments, causing laxity, instability
and subluxation of the vertebral bodies. Subsequent compression of the spinal cord and medulla oblongata can cause severe
neurological deficits and even sudden death. Once neurological deficits occur, progression is inevitable although the rapidity
of progression is highly variable. The first signs and symptoms are pain at the back of the head caused by compression of
the major occipital nerve, followed by loss of strength of arms and legs. The severity of the subluxation can be observed
with radiological investigations (MRI, CT) with a high sensitivity. |
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