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Headmaster Collar Restricts Rheumatoid Atlantoaxial Subluxation |
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Kauppi M, Neva MH, Kautiainen H.
Rheumatism Foundation Hospital, Heinola, Finland.
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STUDY DESIGN: A radiographic study of the effect of a modern orthotic device in the treatment of rheumatoid atlantoaxial subluxation. OBJECTIVE: To study the ability of a new open-type collar to restrict atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA:
Atlantoaxial subluxation is common in rheumatoid arthritis, and thus,
the development of conservative treatments is important. It has been
shown that a custom-made stiff collar significantly restricts
atlantoaxial subluxation in approximately half of patients with
unstable atlantoaxial subluxation. METHODS:
In 30 successive patients with rheumatoid atlantoaxial subluxation,
lateral view radiographs were taken in flexion, extension, and neutral
positions without a collar and in flexion with the Headmaster collar. RESULTS:
The mean atlantoaxial distance during flexion was 7.1 +/- 1.8 mm and
during extension was 1.0 +/- 1.0 mm, and the mean instability was 6.1
+/- 2.3 mm. In the 20 cases with the greatest stabilizing effect, the
mean atlantoaxial distance during flexion with a collar was 1.1 +/- 1.3
mm, whereas in 10 patients with lesser effect it was 6.7 +/- 2.5 mm (P
< 0.0001). The lesser stabilizing effect was associated with the
presence of atlantoaxial subluxation in the neutral position.
CONCLUSION:
The Headmaster collar is an effective and useful tool in the
conservative treatment of simple unstable atlantoaxial subluxation, but
an ordinary custom-made stiff collar is still often needed. These two
collars are complementary, and their selection and use must be
determined individually.
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