Abstract
Effects of the surgical method and extensiveness of surgery, such as atlanto-axial fusion, occipito-cervical short or long fusion, of the subaxial cervical spine were observed in rheumatoid arthritis patients.
Thirty-eight patients were surgically treated and followed for 2 to 24 years (average 4.9 years) . Subaxial subluxation (SAS) progressed in 38% and improved in 19% of the cases. Only one patient showed neurological deficit which subsequently required reoperation.
Risk factors for the appearance or progression of SAS were rheumatoid changes such as irregularity of vertebral endplates and facet joints, disk space narrowing, spontaneous intervertebral fusion, and mobility of the interadjacent vertebrae. Presence of SAS did not always indicate the necessity of extension of surgical fusion to the lower cervical spine. Laminoplasty is an excellent alternative method if combined with upper cervical short fusion.
