Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.

类风湿性关节炎 (RA) 是一种进行性自身免疫性炎症性疾病，影响 1% 的人口，女性人数是男性的三倍。多达 86% 的 RA 患者有颈椎受累。颈椎滑膜炎症会导致不稳定和损伤，包括寰枢椎半脱位、后牙突血管翳形成、颅骨沉降和亚轴半脱位。虽然许多颈椎受累患者无症状，但有症状的患者通常会出现由炎症引起的非特异性症状以及由于脑干、颅神经、椎动脉和脊髓受压引起的其他继发性症状。射线照片是最常用的成像方式，而 MRI 和 CT 用于评估神经元受累和手术计划。存在多种分类系统。颈椎受累的早期诊断和治疗至关重要。当患者因颈椎受累而出现导致生物力学不稳定和/或神经功能缺损的症状时，需要进行手术治疗。寰枢椎融合术治疗寰枢椎不稳，后路减压和寰枢椎融合术或枕颈融合术治疗伴有神经元件受压的齿状突血管翳。可以通过前路减压和后路融合术或仅采用背侧入路来管理颅骨沉降。轴下半脱位通过圆周融合或仅后路减压和融合来管理。寰枢椎不稳定的患者有更好的功能和神经学结果。