Management of cervical spinal lesions in rheumatoid arthritis.

We review the management of cervical spinal lesions in rheumatoid arthritis. Surgical treatment for cervical lesions presents several potential problems, such as spinal cord injury during surgery, prolonged and painful postoperative immobilization, poor outcome incompatible with surgical invasiveness, and a high failure rate of arthrodesis. The introduction of spinal instrumentation techniques to surgery for cervical lesions has solved some of these problems. Rigid spinal fixation using screws, rods, and wires has made surgery more reliable, and has freed patients from painful postoperative immobilization methods such as the Halo vest. However, the effects of surgical treatment have not been clearly examined using methods of evidence-based medicine. There is a need for clinical studies of treatment for cervical lesions, in order to help establish better methods for the management of cervical spinal lesions.