OCCIPITOCERVICAL FIXATION IN RHEUMATOID-ARTHRITIS - AN ANALYSIS OF SURGICAL RISK-FACTORS IN 163 PATIENTS

163 patients with rheumatoid arthritis (RA) and atlanto-axial subluxat ion treated by posterior occipito-cervical fixation (OCF) over a perio d of twenty-one years (November 1970-January 1991) were followed. Comm on complaints prior to surgery were occipital headache, neck pain, rad icular pain and myelopathy. The mean age at time of surgery was 61 yea rs. The mean follow-up time was 54 months. Clinical improvement was ob tained in 88% of the patients, whereas 7% were unchanged and 5% had pr ogressive symptoms in spite of surgery. There was no pre-operative or immediate postoperative mortality. In 79 patients, one or more potenti al surgical risk factors were identified. Twenty-four reoperations wer e performed in the neck. The most common cause for reoperation was mec hanical failure due to wire-break or spinous process fracture. Wound i nfection in the neck was recorded in 16 patients. Five were deep and r equired removal of the fixation material. Following OCF, new or progre ssive subaxial subluxation (SAS) led to further surgery in 4%. The stu dy offers support for the beneficial effect of OCF in rheumatoid AAS. We conclude that, in spite of a number of identified risk factors, OCF with the Brattstrom-Granholm technique remains a safe and effective m ethod for stabilization of upper cervical subluxations in RA.