Narrowing of the spinal canal in the upper cervical spine in rheumatoid arhritis.

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Spinal fusion for deformity of the upper cervical spine was carried out in six patients with rheumatoid arthritis. It was indicated for treating instability, intractable pain, neural involvement, or a combination of these. Procedures were a McGraw fusion of the first and second cervical vertebrae for atlanto-axial subluxation in four cases, and a fusion of the occiput and the forth cervical vertebra for superior migration of the odontoid process and subaxial subluxation in two cases.<BR>The average follow-up period was 27 months. We examined the effect of rheumatoid upper cervical spine on the narrowing of the spinal canal. Complete bony fusion was achieved in all cases. Symptoms were improved in five patients, but not one.<BR>Radiological evaluations were performed in regard to the following subjects; (1) Atlanto-dental interval (ADI) for atlanto-axial subluxation, (2) the McRae method and the Ranawat method for superior migration of the odontoid process and (3) the anteroposterior canal diameter at the level of first cervical spine. The postoperative value of ADI was improved in all cases. Both the postoperative value of vertical migration and narrowing of the spinal canal were, however, increased in two cases although their clinical symptoms were improved.
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