Occipito-cervical fusion in rheumatoid arthritis.
Between 1977 and 1988 twenty-five patients with rheumatoid arthritis involving the cervical spine were treated by an occipito-cervical fusion. Twenty-two patients are included in this study. The main indications for surgery were intractable pain and progressive neural impairment. The operative procedure consisted of an H-bone graft fixed with steel wire in 19 cases, fusion of occiput-C2 six times and of occiput-C3 thirteen times. A Hartshill-Ransford (5, 12) loop was used in three cases: occiput-C3 twice and occiput-C7 once. The mean duration of follow-up was 3 years 8 months in 17 patients. Improvement of symptoms and signs was achieved in 88%. There were 2 post-operative deaths. The high rate of pseudarthrosis in our series was confirmed by several authors. The loop technique provides a more stable fixation and will be our technique of choice in the future.
Department of Orthopaedic Surgery, Ghent University Hospital, Belgium.
A
A
Vanden Berghe
C
C
Ackerman
E
E
Veys
P
P
Verjans
D
D
Uyttendaele
H
H
Claessens
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001864:Bone Wires; D002574:Cervical Vertebrae / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013123:Spinal Fusion / Q000379:methods*