Surgery of the rheumatoid cervical spine. Correlation of the pathology and prognosis.

Twenty-eight rheumatoid arthritis patients with symptomatic subluxation of the cervical spine had 34 operative procedures in the period from 1983 to 1989. Two distinct groups are noted with regard to management and prognosis. The treatment of isolated atlantoaxial instability has been straightforward and the morbidity low. Subaxial instability and combined atlantoaxial and subaxial instability were more difficult to manage: The incidence of preoperative neurologic deficit was higher and the operative technique more demanding. There have been two late deaths of quadriparesis. Half of the other patients were ambulant and independent. The halo jacket has been used to reduce subaxial subluxation and neurologic deficit before surgery. Both anterior and posterior approaches have been successfully employed.