Surgical management of the symptomatic cervical spine in rheumatoid arthritis

Eleven spinal fusions were performed on 10 patients with symptomatic cervical spines secondary to rheumatoid arthritis. A variety of surgical procedures and various types of postoperative immobilization were used. The average patient age at surgery was 43.2 years, with an average followup of 36.9 months. Six of these patients had instability at C1-2, one each at C4-5, C5-6, and C6-7, and one patient had a complete myelographic block without instability at C5-6. Six of the patients presented with neurologic symptoms - all improved; some dramatically. There were no deaths, four transient complications, and no pseudarthroses. Some authors advocate routine, supine, prolonged skull traction postoperatively. We believe that this is not necessary in the uncomplicated rheumatoid spinal fusion, and may be detrimental. Other recommendations for conservative and surgical management are also made.