title: Posterior upper cervical fusion in rheumatoid arthritis.
abstract: The purpose of this study was to determine fusion rates in patients who underwent posterior cervical fusion for instability of the upper cervical spine secondary to rheumatoid arthritis. A retrospective review of clinical and radiographic data was conducted. Nineteen patients underwent posterior cervical fusions limited to the upper cervical spine. There were 11 C1-C2 fusions and 8 occiput-C2 fusions. Instability with pain or neurologic deficits were the main indications. A uniform technique was used in all cases. Preoperative reduction in halo vest or cast was followed by a Gallie type fusion using autogenous iliac bone graft and wire, and postoperative halo vest or cast immobilization for 3 months. A fusion rate of 94% was achieved. The average follow-up was 5 years. Complete or partial relief of pain was obtained in all patients; 30% of those with preoperative deficits improved after surgery. A high fusion rate may be achieved with C1-C2 and occiput-C2 fusions in rheumatoid arthritis, with relief of pain and prevention of neurologic deterioration.
authors.affiliation: Department of Orthopaedics, University of Rochester, New York.
authors.forename: D P
authors.initials: DP
authors.lastname: Chan
authors.forename: K S
authors.initials: KS
authors.lastname: Ngian
authors.forename: L
authors.initials: L
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000601:surgery*; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000601:surgery*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D013997:Time Factors