POSTERIOR UPPER CERVICAL FUSION IN RHEUMATOID-ARTHRITIS

The purpose of this study was to determine fusion rates in patients who underwent posterior cervical fusion for instability of the upper cervical spine secondary to rheumatoid arthritis. A retrospective review of clinical and radiographic data was conducted. Nineteen patients underwent posterior cervical fusions limited to the upper cervical spine. There were 11 C1-C2 fusions and 8 occiput-C2 fusions. Instability with pain or neurologic deficits were the main indications. A uniform technique was used in all cases. Preoperative reduction in halo vest or cast was followed by a Gallie type fusion using autogenous iliac bone graft and wire, and postoperative halo vest or cast immobilization for 3 months. A fusion rate of 94% was achieved. The average follow-up was 5 years. Complete or partial relief of pain was obtained in all patients; 30% of those with preoperative deficits improved after surgery. A high fusion rate may be achieved with C1-C2 and occiput-C2 fusions in rheumatoid arthritis, with relief of pain and prevention of neurologic deterioration.