Extended report
Outcome of cervical spine surgery in patients with rheumatoid
arthritis
K M van Asselta, W F Lemsa, E B Bongartzb, H L Hamburgerc, K W Drossaers-Bakkera, B A C Dijkmansa, R M van Soesbergena
a Department of
Rheumatology, Slotervaart Hospital, Jan van Breemen Institute and the
Academic Hospital Vrije Universiteit in Amsterdam, The Netherlands, b Department of Neurosurgery, Slotervaart Hospital, c Department of Neurology,
Slotervaart Hospital
Correspondence to: Dr R M van Soesbergen, Slotervaart Hospital, Louwesweg 6, 1066 EC Amsterdam redre{at}slz.nl
Accepted for publication 26 September
2000
OBJECTIVES
Cervical
spine instability in patients with rheumatoid arthritis (RA) may lead
to cervical myelopathy or occipital neuralgia, or both. Morbidity and
mortality in patients with RA treated with cervical spine surgery
during two years of follow up were evaluated.
METHODSBetween 1992 and 1996 55 patients with RA underwent cervical spine surgery because
of occipital neuralgia or cervical myelopathy, or both. Patients were
classified according to the Ranawat criteria for pain and neurological
assessment before operation and three months and two years
postoperatively. For occipital neuralgia a successful operation was
defined as complete relief of pain and for cervical myelopathy as
neurological improvement.
RESULTSOccipital
neuralgia was present in 17 patients, cervical myelopathy in 14 patients, and 24 had both. Surgical treatment in the patients with
symptoms of occipital neuralgia who were still alive two years after
surgery was successful in 18/29 (62%). In the surviving patients with
cervical myelopathy neurological improvement of at least one Ranawat
class was seen in 16/24 (67%). Postoperative mortality within six
weeks was 3/51 (6%). Within two years after the operation 14 /51
(27%) of the patients had died; in most patients the cause of death
was not related to surgery. The highest mortality (50%) was found in
the group of six patients with quadriparesis and very poor functional
capacity (Ranawat IIIB).
CONCLUSIONCervical
spine surgery in patients with RA performed because of occipital
neuralgia or cervical myelopathy, or both, is successful in most
patients who are alive two years after surgery. However, the mortality
rate during these two years is relatively high, which seems to be
largely related to the severity of the underlying disease and not to
the surgery itself.
© 2001 by Annals of the Rheumatic Diseases
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