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7 1. Crellin QR, Maccabe JJ and Hamilton EBD: Severe subluxation of the cervical spine in rheumatoid arthritis. J Bone Joint Surg (1970) 52-B, Webb FWS, Hickman JA and Brew DStJ: Death from vertebral artery thrombosis in rheumatoid arthritis. Br Med J (1968) 2, Conlon PW, Isdale IC and Rose BS: Rheumatoid arthritis of the cervical spine. Analysis of 333 cases. Ann Rheum Dis (1966) 25, Weissman BNW, Aliabadi P, Weinfeld MS, Thomas WH and Sosman JL: Prognostic features of atlan to-axial subluxation in rheumatoid arthritis patient. Radiology (1982) 144, Martel W: Occiput-atlanto-axial subluxation in rheumatoid arthritis and ankylosing spondylitis. Am J Rentogenol (1961) 86, Ranawat CS, O'leary P, Pellicci P, Tsairis P, Marchisello P and Dorr L: Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg (1979) 61-A, Steinbrocker O, Traeger CH and Batterman RC: Therapeutic criteria in rheumatoid arthritis. JAMA (I Am Med Assoc) (1949) 140, Ropes MW: 1958 Revision of the diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis (1958) 9, McGraw RW and Rusch RM: Atlanto-axial arthrodesis. J Bone Joint Surg (1973) 55-B, Mathews JA: Atlanto-axial subluxation in rheumatoid arthritis. 5 years follow up study. Ann Rheum Dis.

8 19. Johnell IR: Posterior atlanto-axial dislocation in rheumatoid arthritis. Scand J Rheumatol (1984) 13, Frigaard J: Posterior atlanto-axial subluxation in rheumatoid arthritis. Scand J Rheumatol (1978) 7, Teigland J and Magnas B: Rheumatoid backward dislocation of the atlas with compression of the spinal cord. Scand J Rheumatol (1980) 9, Haaland K, Addland HA, Haavik JK and Vallersnes FM: Atlanto-axial subluxation in rheumatoid arthritis. Scand J Rheumatol (1984) 13, Weiner S, Bassett L and Spiegel T: Superior, posterior and lateral displcement of CI in rheumatoid arthritis. Arth Rheum (1982) 25, Newman P and Sweetnam R: Occipito-cervical fusion. An operative technique. J Bone Joint Surg (1969) 51-B,

9 A case report of five rheumatoid patients with posterior atlanto-axial subluxation Masato NISHIZAWA Department of Orthopaedic Surgery, Okayama University Medical school In progressive rheumatoid arthritis (RA), arthritic affection of the upper cervical spine is relatively common, mainly manifesting atlanto-axial subluxation (AAS). However, posterior AAS (PAAS) is a very rare condition. We reviewed five RA patients with PAAS. All of the pa tients were aged women with progressive RA, who had been treated with steroids and had been hospitalized for many years. Two patients had symptoms of myelopathy due to spinal cord compression, and another one suffered from severe pain in the neck. These three cases were treated surgically with posterior atlanto-axial fusion or posterior occipito-cervical fu sion, and the result was good. Conservative treatment has been indicated for the other two pa tients with only instability as indicated by stress X-ray. X-ray examination confirmed that the most remarkable finding was PAAS due to destruction or disappearance of the odontoid process. The more severely the odontoid process was eroded, the more backward the atlas was dislocated.

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