Cervical spine surgery inpatients withrheumatoid arthritis: anappraisal

Objectives-To reviewtheoutcomeof surgery undertaken tostabilise theneckin patients withrheumatoid arthritis performedoverafive yearperiod, tocompare theresults withthoseofprevious reports, andtoidentify factors thatmay predict surgical outcome. Methods-Outcome wasassessed attime ofdischarge fromhospital after surgery by review ofpatients' notes, andatfollow up bypatient interview, clinical examination, anonymousquestionnaire, andcervical spineradiograph. TheRanawatclassificationofneurological impairment and Steinbrocker functional classification were used. Results-Thirty ninepatients underwent 44procedures; 28patients wereavailable forreviewaftera mean periodof29'8 months(range 12-65months). Fourteen patients had preoperative neurological impairment andwereavailable forfollow up;13returned thequestionnaire. Four (29%)hadimproved Ranawatclass, nine wereunchanged, andonehaddeteriorated. Nine(69%/.) reported a subjective improvement inneurological symptoms byquestionnaire, eventhough theRanawat class wasunchanged infive. Twentyfive of thepatients reviewedhadpainbefore operation; 21returned thequestionnaire. Painrelief wasreported bydirect questioning andquestionnaire in76%and67% ofpatients, respectively. Overall, 67%felt thatsurgery hadbeensuccessful. Surgery wasmoresuccessful inproducing symptomaticrelief inpatients withneckor radicular painthaninthosewithneurological deficit, butdidprevent progression ofneurological symptoms. Conclusions-Our results aresimilar to thosefromothercentres. Overall patient satisfaction with surgerywas good. Surgery wasmorelikely toproduce symptomaticrelief inpatients withneckor radicular painbeforeoperation thanin those withneurological deficit. Thegreater subjective improvement inneurological symptomsas judgedby questionnaire probably reflects therelative insensitivity oftheRanawatclassification indetecting changeinneurological status; previous reportsof pooroutcomeforpatients withneurological symptomswhoundergo surgery may inpartbeareflection ofthe insensitivity ofthismethodofassessment. No clearfactors emergedwhichallowed prediction ofthosepatients atgreatest