Brooks fusion for atlantoaxial instability in rheumatoid arthritis

Atlantoaxial instability in rheumatoid arthritis has been recognized in the natural history of rheumatoid arthritis, but successful surgical stabilization has proven to be elusive. We review our experience using the Brooks technique of wedge compression arthrodesis combined with halo immobilization in five women with rheumatoid arthritis with symptomatic C1-2 subluxation. Halo-vest immobilization was continued for six weeks postoperatively, and then exchanged for a rigid cervical orthosis for an additional six weeks. Solid, asymptomatic fusion developed in all patients within this 12-week period. Follow-up ranges from 18 to 56 months. One major complication occurred in a patient who had significant postoperative quadriparesis in spite of normal intraoperative sensory evoked potentials; it has since slowly resolved.