Cervical spine surgery in rheumatoid arthritis - A Swedish nation-wide registration of 83 patients

Objective-To investigate diagnostic methods, surgical methods and indicatio ns, early complications and short term outcome of cervical spine surgery fo r rheumatoid arthritis (RA). Methods-A nation-wide registration of rheumatoid cervical spine surgery car ried out in Sweden during 1993. Results-Eighty-six (74 primary) procedures in 83 patients were reported fro m 11 hospitals. Pain was a more common indication for surgery than was neur ologic impairment. C1-C2 instability or subluxation was present in 66/82, s ubaxial subluxations in 27/82 and atlantoaxial impaction in 10/82 procedure s (data partly missing in one case). Indications for surgery and preoperati ve investigations were found to be reasonably uniform, but surgical methods and post-operative care varied between hospitals. Posterior fusion was performed in 76 patients. C1-C2 wiring with bone graft ing was the most common procedure followed by occipitocervical fusion with wires and bone cement. Subaxial cervical decompression without fusion, post erior fusion with onlay graft only, and carbon fiber grafts were used in a small number of patients. Total mortality was 5/83. The early complication rate was low, but 17 patie nts showed recurrent subluxation at follow-up at median 7(1-17) months. Sev en of them required reoperation in the same segment. Conclusion-The variation in treatment policy and number of operated patient s in the different hospitals speak in favor For centralization of cervical spine surgery in RA. New methods for C1-C2-fusion need to be evaluated.