Rheumatoid arthritis of the cervical spine

There is a high incidence of cervical involvement in patients with rheumatoid disease. Early evaluation of the neck, close follow-up with dynamic radiographs of the cervical spine, and careful neurological assessment are important in the care of these patients. Surgical stabilization should be considered early even in the absence of neurological findings when significant instability is noted since outcome is related to preoperative neurological function. The type of fusion performed is determined by a careful assessment of the location of instability, patient factors, and the experience of the surgeon with various techniques. The type of postoperative immobilization should be decided on an individual basis depending on the quality of fixation achieved at surgery. Patients must be observed closely in the postoperative period for development of early complications and followed-up for the appearance of pseudarthrosis or late instabilities.