Rheumatoid arthritis of the cervical spine: current techniques for management

Rheumatoid arthritis affects multiple joints with varying degrees of destruction. Later stages of the disease may involve severe mechanical degeneration superimposed on the hypermobile spine. The disease may also have systemic consequences, both vascular and pulmonary. Side effects from the numerous medications used to treat the inflammation, especially steroids, may also result in systemic problems. This article discusses whether and when rheumatoid arthritis of the cervical spine should be treated surgically. The authors suggest an algorithm that can be used to navigate through the numerous details which must be considered to formulate a reasonable surgical plan. Although arthritis patients are frail, an 'aggressive' surgical solution applied in a timely fashion may yield better results than an incomplete or inappropriate surgical solution applied too late.