CERVICAL-SPINE ARTHRODESIS IN RHEUMATOID-ARTHRITIS - A LONG-TERM FOLLOW-UP

Forty-one patients with rheumatoid arthritis involving the cervical sp ine had a posterior cervical arthrodesis. They were followed for a min imum period of seven years. The diagnoses prior to surgery included cr anial settling, atlantoaxial subluxation, subaxial subluxation, and an y combination of these three. All patients had posterior arthrodesis, with or without methylmethacrylate, and iliac crest autogenous bone gr aft. In addition, one patient had an anterior vertebrectomy, and two h ad transoral resection of the odontoid. Follow-up consisted of a subje ctive questionnaire, standard radiographs, and physical examination, i ncluding a neurologic exam. This information was compared to preoperat ive data available in the patient's medical record, postoperative data , and the information obtained in a similar study undertaken in 1987. At the time of follow-up, thirteen patients were known to be dead. One patient could not be located. Of the remaining twenty-six patients, e ighteen underwent the full examination, including physical exam and ra diographs. The remaining nine patients were contacted and interviewed, but were unavailable for exam and radiographs. All patients considere d the operation a success. Only one patient at follow-up had a non-uni on. This was stable over time. No patient had a deterioration in neuro logic function. There was no significant degeneration or instability s een at levels adjacent to the fused segments as compared to the rest o f the cervical spine. Posterior cervical spine arthrodesis for rheumat oid involvement of the neck is a safe, efficacious procedure with no s ignificant deterioration of effects over time.