Craniocervical fusion for rheumatoid arthritis: comparison of sublaminar wires and the lateral mass screw craniocervical fusion

The majority of rheumatoid ar thritis patients with C1/2 instability causing neck pain and neurological compromise can be treated with unisegmental fusion. However, a minority will require decompression and more extensive craniocervical fusion. Two cohorts of patients with rheumatoid arthritis requiring decompression and craniocervical fusion were included in a retrospective study comparing sublaminar wiring (Ransford Loop, n = 10, follow-up = 36 - 9.5 months) and lateral mass screws (Cervifix system, n = 11; follow-up = 39.7 - 7.9 months). Both cohorts of patients experienced significant improvements in high cervical pain scores [McGill 5-point score; preop = 4.5 - 0.75 for Cervifix and 4.5 - 0.75 for Ransford loop; postop = 1.17 - 0.9 ( p = 0.003) for Cervifix (at 39.7 months - 7.9) and 2.8 - 1.6 ( p = 0.011) for Ransford loop (at 36 - 9.5 months)]. Lateral mass screws for craniocervical fusion (seven out of 11 pain free) appear to produce better early results for rheumatoid arthritis patients suffering high cervical neck pain than sublaminar wire techniques (three out of 10 pain free).