Clinical Study of Surgical Treatment for Cervical Spine Lesions in Rheumatoid Arthritis.

The effects of surgical treatment for cervical spine lesions were clinically evaluated in 8 patients with Rheumatoid Arthritis (RA); mutilans type. Six patients complained of pain in the nape and occipital region, and myelopathy was noted in 3 patients. Upper cervical spine lesions were shown in 7 cases and lower in 4 cases. We performed posterior spinal fusion (CO-C2: 5 cases, C1-C2: 2 cases, below C3: 4 cases) for all patients. Posterior decompression was accompanied with posterior spinal fusion in 2 of these cases who had subaxial subluxation with cervical stenosis. Occipitocervical fusion was carried out in 1 patient with atlanto-axial subluxation in the upper cervical spine because vertical subluxation was progressing. After operation immobilization was continued using a halo-vest for an average period of 11 weeks in 7 patients with upper cervical lesions. Solid union was demonstrated radiographically in 7 except 1 patient who had died 8 months after surgery. The condition of all patients improved on early follow-up. Understanding the severity of mutilans RA, could be a better determinant for choosing the appropriate surgical treatment.