Outcome of cervical spine surgery in patients with rheumatoid arthritis

Objectives-Cervical spine instability in patients with rheumatoid arthritis (RA) may lead to cervical myelopathy or occipital neuralgia, or both. Morb idity and mortality in patients with RA treated with cervical spine surgery during two years of follow up were evaluated. Methods-Between 1992 and 1996 55 patients with RA underwent cervical spine surgery because of occipital neuralgia or cervical myelopathy, or both. Pat ients were classified according to the Ranawat criteria for pain and neurol ogical assessment before operation and three months and two years postopera tively. For occipital neuralgia a successful operation was defined as compl ete relief of pain and for cervical myelopathy as neurological improvement. Results-Occipital neuralgia was present in 17 patients, cervical myelopathy in 14 patients, and 24 had both. Surgical treatment in the patients with s ymptoms of occipital neuralgia who were still alive two years after surgery was successful in 18/29 (62%). In the surviving patients with cervical mye lopathy neurological improvement of at least one Ranawat class was seen in 16/24 (67%). Postoperative mortality within six weeks was 3/51 (6%). Within two years after the operation 14 /51 (27%) of the patients had died; in mo st patients the cause of death was not related to surgery. The highest mort ality (50%) was found in the group of six patients with quadriparesis and v ery poor functional capacity (Ranawat IIIB). Conclusion-Cervical spine surgery in patients with RA performed because of occipital neuralgia or cervical myelopathy, or both, is successful in most patients who are alive two years after surgery. However, the mortality rate during these two years is relatively high, which seems to be largely relat ed to the severity of the underlying disease and not to the surgery itself.