Abstract
Twenty-five RA patients who showed spastic quadriparesis and were treated by various surgical methods were studied. Their pathogenesis was classified into 6 groups according to x-ray findings and the type of surgery performed.
Three cases who had posterior subluxation of the atlas are described. In several cases rheumatoid granulations were found in the spinal canal at unstable segments and in multiple facet ankylosis at other levels.
Some cases who had anterior fusion surgery showed an unsatisfactory course. Therefore two methods of surgery are recommended for subaxial lesions in RA with severe cervical myelopathy. If there is multiple level involvement, posterior decompression and posterior fusion should be chosen. If destruction of the cervical vertebral body is found, anterior and posterior fusion is indicated.
For deciding the suitable treatment for RA patients with cervical myelopathy, what is most important is meticulous evaluation of their pathogenesis.
