Review of the spinal complications of rheumatoid disease

Rheumatoid disease affects the cervical spinal cord in the great majority of patients who have had the condition for 10 years or more; Damage to the neuraxis is produced either by direct compression or by repeated microinsults that occur during normal neck movements. Surgery is clearly indicated in patients with obvious and progressive myelopathy and C2 radiculopathy. The cervical spine should be imaged to assess both static and dynamic mechanisms of neuraxis damage. Therapeutic surgery generally involves direct decompression by means of anterior approaches to the neuraxis. If the compression can be reduced by extension of the cervical spine, fusion should be carried out in this position without the need for anterior decompression. An alternative school of thought recommends posterior decompression by laminectomy, a simple fusion technique, and halo jacket immobilization. It remains difficult to predict which patients will progress to myelopathy. The use of absolute bone measurements: such as the posterior atlantodental interval may prove helpful and may be: one of the keys in identifying patients who will benefit from prophylactic surgery.