A stiff collar for the treatment of rheumatoid atlantoaxial subluxation

Conservative treatment of atlantoaxial subluxation (AAS) has tended to be rather passive, since there has been a lack of effective tools. The stabilizing effect of a stiff collar in the treatment of AAS was evaluated. Fifty successive rheumatoid patients with unstable AAS were interviewed and examined clinically. Lateral view radiographs of the cervical spine were taken in neutral position, during flexion and extension without a collar, and during flexion with a stiff collar. Seventeen patients did not have cervical symptoms. A stiff collar was able to significantly stabilize AAS in more than half of the cases, the effect being predictable from neutral-position radiographs. The improvement in bearing enhanced the effect of the collar. The means and strategy of conservative treatment of AAS are discussed.