Methylmethacrylate stabilization for enhancement of posterior cervical arthrodesis in rheumatoid arthritis

Stainless-steel wire, titanium mesh, and perforated titanium sheets and methylmethacrylate were used in conjunction with autogenous iliac-bone grafts to provide immediate stability in difficult or long posterior cervical fusions in eleven patients with rheumatoid arthritis, who were follwed for three to 12.5 years. Two surgical techniques, using methylmethacrylate and metal supplementation of a traditional posterior cervical arthrodesis, are described. One technique includes the occiput, while the other consists of a long posterior fusion that excludes the occiput. In ten of the eleven patients, permanent radiographic stability was maintained as well as a significant reduction of pain and resolution of neural dysfunction. In the eleventh patient a cervical subluxation developed at the distal end of the rigidly fused segment, and eventually the patient died. Four patients who were seen early in the series had wound dehiscences, two of which were infected. Subsequently the methacrylate-metal composite was reduced in volume, and this problem did not recur. In summary, this technique has provided immediate internal splinting and avoided bulky external-fixation devices. It was most useful in fusions of the occiput to the upper part of the cervical spine, in long posterior cervical arthrodeses, and for the repair of pseudarthroses when traditional arthrodesis techniques had failed.