OCCIPITOCERVICAL (BRATTSTROM-GRANHOLM) FUSION FOR RHEUMATOID ATLANTOAXIAL SUBLUXATION - A LONG-TERM FOLLOW-UP OF 147 PATIENTS

147 patients with rheumatoid arthritis (RA) and atlanto-axial subluxat ion operated on with posterior occipito-cervical (Brattstram-Granholm) fusion over an 18 year period (November 1970-November 1988) were foll owed. 112 were female, 35 were men. The mean age at operation was 62 y ears. Before surgery, the major symptoms were occipital headache, neck pain and/or myelopathy. The mean follow-up time was 55 months. Clinic al improvement was obtained in 87 % of the patients, 8 % were unchange d and 5 % had progressive symptoms in spite of surgery. There was no p eroperative or immediate postoperative mortality. 18 reoperations were performed in the neck and 2 at the donor site for the bone transplant . The result offers further evidence for the beneficial effect of post erior occipito-cervical fusion in patients with rheumatoid atlanto-axi al subluxations. We conclude that posterior fusion with the Brattstrom -Granholm technique is a safe and effective method for restabilization of the unstable rheumatoid neck.