A continuing role for pre-operative cervical spine radiography in rheumatoid arthritis?

Pre-operative cervical spine radiographs are routinely requested for patients with rheumatoid disease, prior to elective orthopaedic surgery, but no guidelines exist governing the indications for this investigation. One hundred and twenty-eight such patients were reviewed retrospectively. No patient had signs or symptoms attributable to cervical cord compression. The incidence of unsuspected C1/2 subluxation was 5.5%, and as many as 37% of examinations could have been avoided by assessing previous radiographs. The apparent lack of effect on subsequent anaesthetic management was noticeable. Techniques that do not require hyperextension of the neck were employed in 12 of 19 patients with craniocervical instability and included the laryngeal mask airway, face mask or spinal anaesthesia. However, similar variations in anaesthetic technique were observed in patients without cranio-cervical instability. It is concluded that pre-operative cervical spine assessment in asymptomatic patients with rheumatoid disease is unnecessary, prior to elective orthopaedic surgery.