Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis

In rheumatoid arthritis spontaneous subluxation of cervical vertebrae is not infrequent and can usually be managed by conservative treatment. Surgical treatment, however, is necessary when there is neural involvement. Of twelve patients who had spine fusion for atlanto-axial subluxation only six had solid union. When conservative treatment fails, reduction by halo traction and arthrodesis of the cervical spine is the method recommended, but the best method of post-operative care remains uncertain. In these patients postoperative immobilization was provided by various methods, including a halo cast or brace, but no method appeared to be superior.