The Journal of Bone and Joint Surgery, Vol 71, Issue 3 381-392, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the cervical spine in rheumatoid arthritis
CR Clark, DD Goetz and AH Menezes
University of Iowa Hospitals and Clinics, Iowa City 52242.
Forty-one patients who had rheumatoid arthritis were treated with a
cervical arthrodesis and were followed for a minimum of twenty-three
months. Twenty patients had had an isolated atlanto-axial subluxation;
five, isolated cranial settling; and four, subaxial subluxation alone.
Twenty patients had an atlanto-axial arthrodesis; sixteen, an
occipitocervical arthrodesis; and five, a posterior arthrodesis of the
subaxial spine. In addition, two patients had a transoral odontoidectomy
and one, an anterior cervical vertebrectomy. At the latest follow-up,
thirty-six (88 per cent) of the patients had osseous union, two had fibrous
union but were stable, and three had a non-union. All of the problems with
union occurred in the patients who had had an isolated atlanto-axial
arthrodesis. Clinically, twenty-seven (66 per cent) of the patients had
improved, fourteen were unchanged, and none were worse. The preoperative
neurological status remained the same postoperatively in thirty patients
(73 per cent) and it improved in eleven (27 per cent). Twenty-one of the
twenty-three patients who had had marked pain preoperatively had little or
no pain at the latest follow-up. Complications included a transient
hemiparesis in one patient, a superficial wound infection in two,
displacement of an anterior graft in one, a broken wire in three, and
erosion of methylmethacrylate into the outer part of the occipital cortex
in one. Four patients died, but not as a result of the operation.(ABSTRACT
TRUNCATED AT 250 WORDS)
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