Rheumatoid Arthritis: Spinal Manifestations and Surgical Treatment

Abstract

Rheumatoid arthritis affects an estimated 1.3 million persons in the United States. It can be an extremely morbid disease, with cervical spine involvement leading to significant disability and even mortality. We describe the current diagnostic modalities and treatment algorithm for rheumatoid arthritis of the cervical spine. New antirheumatic drugs allow for marked improvement of joint involvement for all joints affected by rheumatoid arthritis. The three forms of cervical instability secondary to rheumatoid arthritis are atlantoaxial instability, atlantoaxial impaction (vertical settling), and subaxial subluxation. Surgery is considered for patients with intractable neck pain, neurologic deficits, and specific radiographic criteria. Both anterior and posterior surgical techniques are viable options depending on the surgical pathologic findings involved. Many studies have shown that patients with lower Ranawat scores have better long-term outcomes after surgical stabilization. Early intervention in patients with neurologic deficits in the setting of cervical spine instability provides the best chance for improved neurologic function.

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