Abstract
Nine rheumatoid patients who suffered from severe neck-occipital pain with cervical myelopathy were operated by using a Luque's segmental spinal instrumentation (modified U-shaped rod). Five of the patients had mutilating disease. Occipital-upper thoracic fusion and decompressive laminectomy were carried out for the five mutilating patients who had upper cervical lesions along with severe subaxial subluxation and instability. Neck-occipital pain and cervical myelopathy were improved after surgery in all the five mutilating patients. However, in one case, postoperative instability was appeared on the upper thoracic level just below the fusion level. Occipital-upper cervical fusion was carried out for the four non mutilating patients who had vertical subluxation or irreducible atlanto-axial subluxation. In three of those cases, laminoplasty was performed below the fusion level. Neck-occipital pain was improved in all the four cased after surgery. However, in two cases with occipital-C3 fusion, mild instability on the fusion site remained postoperatively.
