Abstract
The incidence of cervical lesion in rheumatoid arthritis (RA) was studied on roentgenograms taken preoperatively. Four roentgenograms (antero-posterior, lateral including stress views) were examined by one of our members (Y. M.) . The total number of cases was 63. All were diagnosed as classical RA and had had surgical treatments. There were 9 males and 54 females averaging 57 years in age, ranging from 30 to 76, with a contraction period of 16 years on an average. Cervical lesion was found in 48 cases, and subluxation in 41; an incidence of 76% and 65% respectively. When operative treatments were selected for these RA patients, careful management was essential, especially during general anesthesia and the operation.
Magnetic Resonance Imaging was applied on 10 RA patients and compared with the. plain roentgenograms and clinical findings. Four cases had atlanto-axial subluxation (AAS), 2 had vertical subluxation (VS), 1 had subaxial subluxation (SAS), and 4 had multiple disc narrowing. Only 2 cases showed compression of the spinal cord from the front and discontinuity of the spinal fluid. But MRI doesn't give good contrast yet and requires too long a time to take for RA patients. It was concluded that the best method for RA cervical lesion was to apply the short spin echo method on the stressed neck.
Halo-vest was applied on the 6 operated cases including 2 cases of AAS, 2 of VS and 2 of SAS. The method of operation was anterior body fusion in the 2 SAS cases and posterior fusion in the other 4. The average follow-up period was 10 months (4 to 20 months) . All cases became able to walk with or without aids. Though the short follow-up study indicated satisfactory results, general complications, such as ileus and gastric ulcer, occurred in 4 cases during Halo-vest fixation.
