Stabilization of the unstable upper cervical spine in rheumatoid arthritis.

We present our clinical experience and the results of surgical treatment of 13 patients with rheumatoid involvement of the cervical spine, namely severe atlanto-axial dislocation. A posterior fusion was carried out using a bicortical H-shaped iliac crest bone graft and steel wire. Postoperatively all patients were immobilized for 8 weeks in a Halo cast. There were no postoperative complications and all patients showed a stable fusion confirmed by radiography. Complete pain relief was obtained in 9 patients, partial in 4.