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Upper cervical instability in rheumatoid arthritis.

T K Fehring, A L Brooks

Clinical Orthopaedics and Related Research

|August 1, 1987

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Upper cervical fusion effectively improved neurologic symptoms and pain in rheumatoid arthritis patients. However, achieving solid fusion remains challenging, necessitating technique modifications for better outcomes.

Area of Science:

Orthopedics
Rheumatology
Neurosurgery

Background:

Upper cervical instability is a serious complication for patients with rheumatoid arthritis.
Current treatment protocols for rheumatoid arthritis patients with upper cervical instability are being evaluated.

Purpose of the Study:

To determine the efficacy of current treatment protocols for upper cervical instability in rheumatoid arthritis patients.
To assess the outcomes of upper cervical fusions in this patient population.

Main Methods:

A retrospective review of 17 patients who underwent upper cervical fusions for instability.
Evaluation of neurologic status and pain levels before and after surgical intervention.

Main Results:

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Ten of 11 patients with neurologic symptoms showed improvement.

All patients with preoperative pain experienced at least a one-grade improvement.

Complete pain relief was achieved in only five patients.

A 25% pseudarthrosis rate highlights challenges in achieving solid fusion in rheumatoid disease.

Conclusions:

Upper cervical fusion can improve neurologic status and pain in rheumatoid arthritis patients.
Achieving solid arthrodesis is difficult in rheumatoid disease, suggesting a need for technique modification.
Modifications to the wedge compression technique may improve fusion rates in rheumatoid patients.