neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2025-27-2-90-99neurosurgery-1687Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEХирургическая коррекция фиксированной цервикомедуллярной компрессии на краниовертебральном уровне у пациентки с поздней стадией ревматоидного артрита (клиническое наблюдение и обзор литературы)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)https://orcid.org/0000-0002-1881-2088СтепаненкоВ. В.StepanenkoV. V.

194354 Санкт-Петербург, Учебный пер., 5

5 Uchebnyy Pereulok, Saint-Petersburg 194354

https://orcid.org/0009-0001-4621-5504ШаманинВ. А.ShamaninV. A.

194354 Санкт-Петербург, Учебный пер., 5

5 Uchebnyy Pereulok, Saint-Petersburg 194354

https://orcid.org/0000-0003-4770-3400ТрашинА. В.TrashinA. V.

Александр Вадимович Трашин

194354 Санкт-Петербург, Учебный пер., 5

192242 Санкт-Петербург, ул. Будапештская, 3

Aleksandr Vadimovich Trashin 

5 Uchebnyy Pereulok, Saint-Petersburg 194354

3 Budapestskaya St., Saint-Petersburg 192242

atrashin@gmail.comhttps://orcid.org/0000-0002-0696-0200ШулёвЮ. А.ShulevYu. A.

194354 Санкт-Петербург, Учебный пер., 5

192242 Санкт-Петербург, ул. Будапештская, 3

5 Uchebnyy Pereulok, Saint-Petersburg 194354

3 Budapestskaya St., Saint-Petersburg 192242

СПб ГБУЗ «Городская многопрофильная больница № 2»РоссияCity Multifield Hospital No. 2Russian FederationСПб ГБУЗ «Городская многопрофильная больница № 2»; ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И. И. Мечникова» Минздрава РоссииРоссияCity Multifield Hospital No. 2; I. I. Mechnikov North-West State Medical University, Ministry of Health of RussiaRussian Federation2025180820252729099Copyright © Степаненко В.В., Шаманин В.А., Трашин А.В., Шулёв Ю.А., 20252025Степаненко В.В., Шаманин В.А., Трашин А.В., Шулёв Ю.А.Stepanenko V.V., Shamanin V.A., Trashin A.V., Shulev Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1687

В статье представлены обзор литературы и редкое клиническое наблюдение хирургической коррекции фиксированной цервикомедуллярной компрессии (ФЦК) при ревматоидном артрите (РА) с поражением краниовертебральной области. Продемонстрированы возможности декомпрессивно-стабилизирующей операции в хирургической реабилитации пациентки с тяжелой формой РА. Длительность наблюдения составила более 11 лет.

При первом обращении пациентке была проведена двухэтапная хирургическая коррекция за одну операцию: 1-й этап – трансоральная декомпрессия (резекция зуба и 2 / 3 тела позвонка С2); 2-й этап – окципитоцервикальная фиксация C0-С3-C4-C5-C6.

Хирургическое лечение позволило полностью восстановить функциональную независимость пациентки. При повторном обращении (через 11 лет) выполнен перемонтаж элементов фиксирующей конструкции.

Клиническое наблюдение демонстрирует влияние ФЦК при поздней стадии РА на функциональный статус пациентки, а также возможности двухэтапной реконструктивно-стабилизирующей коррекции. Двухэтапная хирургическая коррекция при ФЦК – ключевой этап хирургической реабилитации, обеспечивающий возможность возвращения пациентам функциональной независимости.

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.

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The authors declare that there are no conflicts of interest present.