Posterior Instrumented Occipitocervical Fusion in Inflammatory Arthritis

The outcome of posterior instrumented occipitocervical fusion (PIOF) in eighteen consecutive patients was evaluated. Seventeen patients had rheumatoid arthritis (RA); the other had psoriatic arthritis. Ranawat Grade (RG) before surgery was 2 in 28%, 3a in 55%, and 3b in 17%. Mean Pain Visual Analogue Score (VAS) before surgery was 8.8/10. All patients had an atlantodens interval of > 5mm and vertical migration of the odontoid and 6 patients had posterior atlantodens interval of < 13 mm. Mean follow-up was 24 months (range 3 - 56, one death at 3 months). 78% had a postoperative RG of zero, and 83% had an improvement of at least 2 grades on the RG. Postoperative VAS declined by a mean of 7.8. There were 3 deaths, and 6 complications.

This study supports previous findings that PIOF is a safe and effective procedure for inflammatory arthritis with severe craniocervical involvement.