Rheumatoid arthritis (RA) might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery (HRVA) puts patients at risk of injuring the vessel. RA is hypothesized to increase a risk of HRVA. However, to date, no relative risk (RR) has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. All major databases were scanned for cohort studies combining words “rheumatoid arthritis” and “high-riding vertebral artery” or synonyms. RA patients were qualified into the exposed group (group A), whereas non-RA subjects into the unexposed group (group B). Risk of bias was explored by means of Newcastle-Ottawa Scale. MOOSE checklist was followed to ensure correct structure. Fixed-effects model (inverse variance) was employed. Four studies with a total of 308 subjects were included in meta-analysis. One hundred twenty-five subjects were in group A; 183 subjects were in group B. Mean age in group A was 62,1 years, whereas in group B 59,9 years. The highest risk of bias regarded “comparability” domain, whereas the lowest pertained to “selection” domain. The mean relative risk of HRVA in group A (RA) as compared with group B (non-RA) was as follows: RR = 2,11 (95% CI 1,47–3,05), I² = 15,19%, Cochrane Q = 3,54 with overall estimate significance of p < 0,001. Rheumatoid arthritis is associated with over twofold risk of developing HRVA, and therefore, vertebral arteries should be meticulously examined preoperatively before performing craniocervical fusion in every RA patient.

类风湿性关节炎 (RA) 可能导致需要经椎弓根或经关节融合术的寰枢椎不稳定。高位椎动脉 (HRVA) 使患者面临损伤血管的风险。假设 RA 会增加 HRVA 的风险。然而，迄今为止，尚未计算相对风险 (RR) 来定量确定 RA 作为其风险因素的真实影响。据我们所知，这是第一次尝试这样做。扫描了所有主要数据库中包含“类风湿性关节炎”和“高位椎动脉”或同义词的队列研究。RA 患者被纳入暴露组（A 组），而非 RA 受试者被纳入未暴露组（B 组）。通过纽卡斯尔-渥太华量表探讨偏倚风险。遵循 MOOSE 检查表以确保正确的结构。采用固定效应模型（逆方差）。四项研究共 308 名受试者被纳入荟萃分析。A组有125名受试者；B 组有 183 名受试者。A 组的平均年龄为 62.1 岁，而 B 组的平均年龄为 59.9 岁。偏差风险最高的是“可比性”领域，而最低的是“选择”领域。与 B 组（非 RA）相比，A 组（RA）中 HRVA 的平均相对风险如下：RR = 2,11（95% CI 1,47–3,05），而最低的是“选择”域。与 B 组（非 RA）相比，A 组（RA）中 HRVA 的平均相对风险如下：RR = 2,11（95% CI 1,47–3,05），而最低的是“选择”域。与 B 组（非 RA）相比，A 组（RA）中 HRVA 的平均相对风险如下：RR = 2,11（95% CI 1,47–3,05），I ²  = 15,19%，Cochrane Q = 3,54，总体估计显着性为p  < 0,001。类风湿性关节炎与发生 HRVA 的风险超过两倍，因此，在对每位 RA 患者进行颅颈融合术之前，应在术前仔细检查椎动脉。