Abstract
We reviewed the clinical and radiographic results of posterior fusion for upper cervical spinal lesions in 31 rheumatoid patients managed between 1973 and 1982.
The average age of the patients at the time of surgery was 54 years and ranged from 34 to 72 years.
The average duration of follow-up was 156 months (13 years) and ranged from 122 to 192 months (10-16 years) .
The subjects included 19 patients who had undergone atlantoaxial posterior fusion (McGraw method) for anterior subluxation of C1 on C2, 8 patients who had undegone occiput-atlas-axis fusion for vertical subluxation and 4 patients who had undergone spinal fusion above and below C2.
All 5 patients who had developed tetraparesis prior to surgery improved with direct traction and continued to do well. Of the 20 patients with myelopathy, 13 improved with surgery, but the myelopathy persisted in seven patients. Ranawat's evaluation of these 20 patients before and after surgery indicated that 18 showed improvement.
All 31 patients had complained of neck pain, and only one patient with pseudoarthrosis continued to complain of severe neck pain following surgery. No patients suffered aggravated symptoms or complications from the surgery.
Among the 19 people with anterior subluxation of C1 on C2 were two cases of radiographical pseudoarthrosis and six cases of reduction failure. Clinical radiographic signs improved in all of these patients and all patients remained stable. We studied microscopic lesions in four of the seven patients who had died after surgery and all patients exhibited bony fusion, which indicated that the surgery was successful. Spinal demyelinization around the compressed site was apparent, however, and this was similar in non-operated autopsy cases.
