Abstract
Surgical fusion of the upper cervical spine was done in 17 patients, 13 women and 4 men, with rheumatoid arthritis. The average follow-up was 3, 4 years. Using the functional classification of the ARA, 4 patients were classified as being class I or II ; 10 in class i and 3 in class IV.
Our criteria for choosing the surgical method were as follows: (1) reducible or irreducible atlanto-axial subluxation, (2) with or without neural involvement, (3) with or without penetration of the dens, and (4) the active nature of rheumatoid arthritis. Atlanto-axial fusion was performed in 10 patients and occiputo-axial or subaxial fusion in 7.
A solid arthrodesis was obtained in all patients and a satisfactory result was produced except for the presence of neural involvement. As there are often progressive radiological changes in the cervical spine after initially successful surgery, long-term follow-up evaluation is necessary.
