Is surgery indicated for neck pain in rheumatoid arthritis?
Non specific axial and interscapular pain is extremely common and best treated symptomatically, not surgically. Some pains are worth investigation, such as pain behind the ear or “occipital migraine” especially if accentuated by yawning, chewing or rotating the head. This may indicate a C2 nerve root irritation as it crosses an inflamed and/or unstable atlantoaxial lateral mass joint. Plain radiographs are insufficient and imaging necessary. Relief with a local anaesthetic injection will confirm the diagnosis and with intractable pain, an atlantoaxial fusion may be used. In the lower cervical spine, brachalgia and nerve root symptoms and signs may indicate root irritation or compression. Again imaging will be necessary to adequately evaluate the condition. Are there “absolute” radiological measurements in the upper cervical spine to suggest surgery? Atlantoaxial subluxation is the commonest radiological abnormality seen in RA; rarely before 5 years and almost invariable after 25 years
