In rheumatoid arthritis spontaneous subluxation of cervical vertebrae is
not infrequent and can usually be managed by conservative treatment.
Surgical treatment, however, is necessary when there is neural involvement.
Of twelve patients who had spine fusion for atlanto-axial subluxation only
six had solid union. When conservative treatment fails, reduction by halo
traction and arthrodesis of the cervical spine is the method recommended,
but the best method of post-operative care remains uncertain. In these
patients postoperative immobilization was provided by various methods,
including a halo cast or brace, but no method appeared to be superior.