A CONTINUING ROLE FOR PREOPERATIVE CERVICAL-SPINE RADIOGRAPHY IN RHEUMATOID-ARTHRITIS

Pre-operative cervical spine radiographs are routinely requested for p atients with rheumatoid disease, prior to elective orthopaedic surgery , but no guidelines exist governing the indications for this investiga tion, One hundred and twenty-eight such patients were reviewed retrosp ectively. No patient had signs or symptoms attributable to cervical co rd compression. The incidence of unsuspected C1/2 sublulation was 5.5% , and as many as 37% of examinations could have been avoided by assess ing previous radiographs. The apparent lack of effect on subsequent an aesthetic management was noticeable. Techniques that do not require hy perextension of the neck were employed in 12 of 19 patients with crani ocervical instability and included the laryngeal mask airway, face mas k or spinal anaesthesia, However, similar variations in anaesthetic te chnique were observed in patients without cranio-cervical instability. It is concluded that pre-operative cervical spine assessment in asymp tomatic patients with rheumatoid disease is unnecessary, prior to elec tive orthopaedic surgery.