Posterior surgical stabilization for atlantoaxial subluxation in rheumatoid arthritis

Twelve patients with rheumatoid arthritis involving the cervical spine were treated with posterior surgical stabilization for atlantoaxial instability. There were two occiput C2 fusions with one death and ten C1-2 fusions with nine successful fusions, giving an overall 84% satisfactory results and 90% satisfactory results in the C1-2 fusions alone. It is proposed that careful attention to operative positioning and postoperative management are responsible for the better results reported in this series than recent reports of operative treatment of similar patients. The use of halo traction intraoperatively with careful attention to positioning of the neck and halo cast postoperatively are advocated.