How are combined subluxations treated in patients with rheumatoid arthritis (RA) of the cervical spine?

Updated: Aug 13, 2019
  • Author: Steven R Garfin, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Some patients may have upper cervical involvement as well as early subaxial subluxation. In these instances, the fusion should be extended to include the involved subaxial segments to avoid early deterioration of borderline subluxations below a rigid upper cervical fusion (see the image below).

Rheumatoid spondylitis. Occipitocervical fusion co Rheumatoid spondylitis. Occipitocervical fusion combined with lateral mass plating for a patient with combined superior migration of the odontoid and subaxial subluxation. Courtesy of Steven R. Garfin.

Postoperatively, the type of orthosis used in those with combined subluxations is often best determined on an individualized basis. Many patients have porotic bone of both the posterior elements and of the structural graft harvested from the iliac crest. Upper cervical fusions in such patients may best be managed postoperatively in a halo. When rigid collars are used, careful surveillance of the skin is mandatory to avoid decubiti. Also, if temporomandibular joint (TMJ) involvement is present, eating (chewing) may be a problem in a cervical-thoracic orthosis (CTO).

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