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The Journal of Bone and Joint Surgery, Vol 61, Issue 7 1003-1010, Copyright © 1979 by Journal of Bone and Joint Surgery, Inc
Cervical spine fusion in rheumatoid arthritis
CS Ranawat, P O'Leary, P Pellicci, P Tsairis, P Marchisello and L Dorr
Spinal fusion for deformity of the cervical spine was done in thirty-three
patients with rheumatoid arthritis. The average follow-up was three years.
The deformities present were atlano-axial subluxation, superior migration
of the odontoid process into the foramen magnum, and subaxial subluxation
of the vertebral bodies. We devised a classification of the pain and the
neural involvement in these patients and a new method of measuring superior
migration. The surgical procedures for treating instability, intractable
pain, or neural involvement, or a combination of the three, were: (1) a
Gallie fusion of the first and second cervical vertebrae for atlanto-axial
subluxation, (2) a fusion of the occiput and the second cervical vertebra
for superior migration of the odontoid process, and (3) a posterior fusion
for subaxial subluxation. The occiput was included in the fusion if
superior migration of the odontoid process was demonstrated. The results
show that four of five patients who had an anterior fusion had no
improvement. Twenty-five patients had posterior fusion; in seventeen the
condition was improved, in five there was improvement, and in three the
condition was worse. Of nineteen patients with neural involvement, the
condition was improved in eight, it was unchanged in seven, and it was made
worse in two. There were three postoperative deaths and six additional
unrelated deaths within two years of surgery. There were five
pseudarthroses.
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