title: Surgical management of cervical spine instability in rheumatoid arthritis patients.
abstract: OBJECTIVE
  Cross-sectional study that aims to evaluate the results of cervical spine surgeries due to rheumatoid arthritis (RA) instability, between January of 2000 and of 2012 in a main Portuguese centre.
  
  
  METHODS
  Patients followed on Rheumatology submitted to cervical spine fusion due to atlantoaxial (AAI), sub-axial (SAI) or cranio-cervical (CCI) instabilities between 2000-2012 were included. Information about the surgical procedure and associated complications was gathered and imagiologic and clinical indexes before and after surgery (as anterior and posterior atlanto-axial interval and Ranawat index) were evaluated and compared using adequate statistics.
  
  
  RESULTS
  Forty-five patients with RA were included: 25 with AAI, 13 with CCI and 7 with SAI. Ten AAI and 4 CCI patients were submitted to wiring stabilization techniques; 15 AAI and 9 CCI patients to rigid ones; and in all patients with SAI an anterior cervical arthrodesis was chosen. There is a significant increase in PADI and a decrease in AADI in the postoperative evaluation (p<0,05) that only remains significant when rigid systems were used. After surgery the Ranawat index decreased (p<0,05) and no patient showed a deterioration of neurological condition. The complication rate was of 23,1%, with 5 mal-unions.
  
  
  CONCLUSIONS
  Surgical management of cervical column instabilities in patients with rheumatoid arthritis seems to be a safe procedure, with a high rate of neurologic improvement. Rigid techniques seem to lead to a better imagiological improvement when compared to wiring ones.
authors.forename: P M
authors.initials: PM
authors.lastname: Marques
authors.forename: P
authors.initials: P
authors.lastname: Cacho-Rodrigues
authors.forename: M
authors.initials: M
authors.lastname: Ribeiro-Silva
authors.forename: D
authors.initials: D
authors.lastname: Linhares
authors.forename: P
authors.initials: P
authors.lastname: Negrão
authors.forename: R
authors.initials: R
authors.lastname: Pinto
authors.forename: N
authors.initials: N
authors.lastname: Neves
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications; D002574:Cervical Vertebrae; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies