Subaxial cervical spine subluxation in rheumatoid arthritis: A retrospective analysis of 16 operated patients after 1-5 years

We evaluated the clinical and radiological outcomes in 16 patients (15 women) having rheumatoid arthritis with a mean age of 66 (55-77) years, on average 2 (1-5) years after decompression and stabilization, for subaxial subluxation of the cervical spine. The duration of rheumatoid arthritis averaged 30 (10-67) years and the duration of neck symptoms averaged 15 (1-60) months. Preoperatively, 11 of the patients had pain in the neck, all 16 suffered from arm rhizopathy and varying degrees of myelopathy. 4/5 patients with severe myelopathy died within 3 months of surgery. Fixation failure occurred in 7 patients, but had no clinical significance in 5. There were 1 deep infection and 1 nerve root lesion resulting in deltoid weakness. Other complications were dysphagia and donor-site pain. 4 reoperations were performed, 2 extension of fusion, 1 revision of infection, and 1 foraminotomy. Neck pain was reliably relieved, while arm rhizopathy was less positively affected. Myelopathy carried a poor prognosis for relief and its occurrence correlated with death. Early treatment, before significant myelopathy has developed, is recommended. Decompression, both via realignment and bone resection, followed by fusion of the entire cervical spine, is advocated. Due to the poor bone quality and with the presently available implant systems, simultaneous anterior and posterior fixation is beneficial.