Rheumatoid arthritis of the cervical spine

The synovitis of rheumatoid arthritis (RA) injures structures in the cervical spine, allowing atlantoaxial subluxation, atlantoaxial impaction, and subaxial subluxation. Spinal cord and vertebral artery injury can ensue. Subluxations are common, but neurologic abnormalities are less so. Patients with RA can die from subluxations but usually do not, although many become worse with time. Nonsurgical management is supportive and designed to lessen pain. Neurologic abnormality is the major indication for surgery. Preoperative skeletal traction is often needed. Posterior fusion is most commonly done for stabilization.