Cervical Arthritis (Juvenile Rheumatoid Arthritis)
Rheumatoid arthritis (RA) is an autoimmune disease that inflames and destroys the lining of the joints in the body, called the synovial tissue. Cervical arthritis can result in neurological damage and possible paraplegia .
Signs and Symptoms
Common symptoms of cervical arthritis include:
- Neck pain
- Weakness or numbness
- Stiffness of the neck
- Difficulty with movement or coordination of the arms and hands
- Low grade fever
- Discomfort or malaise
- Loss of appetite
Diagnosis of cervical arthritis starts with a physical exam and medical history. Other procedures and tests may be needed to diagnose, including x-rays , computed tomography) , magnetic resonance imaging (MRI) and blood tests which show the levels of rheumatoid factor (RF) and anti-nuclear antigen (ANA).
There are several treatment options for cervical arthritis:
- Physical therapy
- Minimally invasive posterior cervical discectomy This procedure is usually performed because of nerve root compression. During surgery, a small incision will be made on the back of your neck. Your surgeon will remove bone and ligament to get access to the spinal canal. Using a microscope, the nerve will be identified and the pressure will be taken off by removing disc material. During this surgery, no fusion will be performed. Surgery typically takes 1-2 hours and typically you go home the same day.
- Cervical decompression and fusion The surgery is usually done for degenerative conditions of the spine. First, an incision is made on the front or back of the neck depending on surgeon preference and your anatomy. Then, we dissect through the tissues of the neck carefully until we identify the cervical spine. We make sure that we are in the right location using x-rays. We then remove the disc starting superficially, then deeper in the joint space until we work all the way through the joint and enter the spinal canal where the bone spurs or disc herniation compresses the nerves. We remove the compressive pathology very carefully as the nerves that are in that area are very delicate. After we get all of the pressure off of these delicate nerves, we then reconstruct the joint using an implant of cadaver bone or a cage made of synthetic materials. A metal plate and screws then are secured to the spine so that the bones of that segment will heal/fuse and remain stable. The wound is closed with stitches under the surface that dissolve after the skin has healed.
- Facet joint injection/medial branch nerve block A small needle is advanced with the help of a fluoroscopy or x-ray machine. Brief x-rays are taken to help direct the needle to the correct location. A small amount of local anesthetic and possibly steroid is slowly injected in the appropriate location.
- Radiofrequency lesioning/neurolytic procedures/rhizotomies All nerves regenerate over time, so the results will not last forever, however, many patients experience pain relief that lasts 6 months to over a year. This procedure is performed by a physician board certified in anesthesia and pain medicine using live x-ray in either the office or surgery center setting. This procedure typically takes about 20-30 minutes and may be performed either with local anesthetic, oral sedation or IV sedation in the surgery center, depending on patient preference. The procedure involves a special needle, which is advanced to the target area under fluoroscopic (x-ray) guidance. A small amount of electrical current is then utilized to demonstrate proper placement along the targeted nerve. You will feel a buzz or tapping sensation, but it typically isn’t painful. Once the needle has been properly placed, a local anesthetic will be placed into the targeted area. The radiofrequency ablation will then be performed which typically lasts a few minutes. A combination of local anesthetic and injectable steroids are then injected before the needle is removed.