To the Editor:
We read with interest the article C1-C2 Intra-articular Screw Fixation for Atlantoaxial Subluxation Due to Rheumatoid Arthritis (www.orthosupersite.com/view.asp?rID=37205) in the March 2009 issue of ORTHOPEDICS. The authors present a technique for the treatment of rheumatoid arthritis affecting the craniovertebral junction. They introduce an intra-articular spacer in the form of a screw and subsequently perform a posterior fixation by one of several available methods.
It is surprising that the authors could not locate any of our several published articles mentioning the use of intra-articular spacers. We have used intra-articular spacers in the treatment of basilar invagination, mobile and irreducible atlantoaxial dislocation, and rheumatoid arthritis.1-13 We first published the use of intra-articular spacers for rheumatoid arthritis-related craniovertebral instability in 2004.6,9 We did our first case of rheumatoid arthritis in November 2001.12 Over the years, we have used stainless steel, acrylic, and titanium spacers. We also reported the use of spiked titanium spacers that can stabilize the region by themselves so posterior fixation can be entirely avoided.
At best, the authors spacer is a modification of the spacer we described. The authors have unjustifiably not included our references on our technique of atlantoaxial fixation as well, despite the fact that they have used them in their patients.14,15
It is clear that the authors wish to make their spacer commercial and have deliberately avoided our publications. The present publication is against all scientific norms and a violation of the authenticity of published work.
- Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004; 1(3):281-286.
- Goel A. Craniovertebral anomalies: role for craniovertebral realignment. Neurol India. 2004; 52(4):427-429.
- Goel A. Atlanto-axial joint distraction in the treatment of select cases of basilar invagination, syringomyelia and fixed atlanto-axial dislocation. Nepal Journal of Neuroscience. 2005; (2):1-6.
- Goel A. Progressive basilar invagination after transoral odontoidectomy: treatment by atlantoaxial facet distraction and craniovertebral realignment. Spine (Phila Pa 1976). 2005; 30(18):E551-555.
- Goel A. Atlantoaxial joint jamming as a treatment for atlantoaxial dislocation: a preliminary report. Technical note. J Neurosurg Spine. 2007; 7(1):90-94.
- Goel A, Dange N. Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction. Case report. J Neurosurg Spine. 2008; 9(3):273-276.
- Goel A, Kulkarni AG, Sharma P. Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine. 2005; 2(4):505-509.
- Goel A, Muzumdar D, Dange N. One stage reduction and fixation for atlantoaxial spondyloptosis: report of four cases. Br J Neurosurg. 2006; 20(4):209-213.
- Goel A, Pareikh S, Sharma P. Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis. Neurol India. 2005; 53(2):238-240.
- Goel A, Shah A. Atlantoaxial joint distraction as a treatment for basilar invagination: a report of an experience with 11 cases. Neurol India. 2008; 56(2):144-150.
- Goel A, Shah A. Reversal of longstanding musculoskeletal changes in basilar invagination after surgical decompression and stabilization. J Neurosurg Spine. 2009; 10(3):220-227.
- Goel A, Sharma P. Craniovertebral realignment for basilar invagination and atlantoaxial dislocation secondary to rheumatoid arthritis. Neurol India. 2004; 52(3):338-341.
- Goel A, Sharma P. Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: preliminary report of 12 cases. Neurol Med Chir (Tokyo). 2005; 45(10):512-517.
- Goel A, Laheri V. Plate and screw fixation for atlanto-axial dislocation. Acta Neurochir (Wien). 1994; 129(1-2):47-53.
- Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: A report of 160 treated patients. Neurosurgery. 2002; 51(6):1351-1356.
We disagree with Professor Goel that our intra-articular screw fixation is an imitation of his procedure.
Our intra-articular screw fixation procedure was first published globally titled C1-C2 Intra-articular Screw Fixation for Atlantoaxial Posterior Stabilization, in the journal Spine in 2000.1 Furthermore, we presented this procedure at the 30th Annual Meeting of the Cervical Spine Research Society in Miami Beach, Florida, December 6, 2002.2
Our first case was a patient with rheumatoid arthritis in February 1995, and a preliminary report of our first series was published by a Japanese paper in 1996.3 The present article reports clinical results of patients with rheumatoid arthritis an average of 5 years and 1 month postoperatively.
Therefore, our idea came before the work of Professor Goel. Our only regret is that we did not confirm Professor Goels series of papers in 2004.
Yasuaki Tokuhashi, MD
Yasumitsu Ajiro, MD
Masashi Oshima, MD
Natsuki Umezawa, MD
- Tokuhashi Y, Matsuzaki H, Shirasaki Y, Tateishi T. C1-C2 intra-articular screw fixation for atlantoaxial posterior stabilization. Spine (Phila Pa 1976). 2000; 25(3):337-341.
- Tokuhashi Y, Matsuzaki H. C1-C2 intra-articular screw fixation for atlantoaxial posterior stabilization. Paper presented at: 30th Annual Meeting of Cervical Spine Research Society; December 5-7, 2002; Miami Beach, Florida.
- Tokuhashi Y, Matsuzaki H, Ohkawa A, Ishihara K, Wakabayashi K, Sano S. C1-2 intra-articular screw fixation combined with spinal instrumentation for atlantoaxial subluxation. J East Jpn Orthop Traumatol. 1996; 8(2):212-216.