Upper cervical instability in rheumatoid arthritis.

Upper cervical instability remains a significant problem for the patient with rheumatoid arthritis. Seventeen patients treated by upper cervical fusions for instability, were followed to determine the efficacy of our current treatment protocol. Improvement in neurologic status was observed in ten of 11 patients presenting with neurologic symptoms. In all patients with preoperative pain, improvement occurred at least one grade. However, complete amelioration of pain was noted in only five patients. A pseudarthrosis rate of 25% reflects the difficulty in achieving a solid arthrodesis in the patient with rheumatoid disease. Modification of the wedge compression technique may help ensure arthrodesis in rheumatoid patients.