Bracing of the cervical spine in patients with rheumatoid arthritis, ankylosing spondylitis and instability due to metastases poses special problems. Because of asymmetry, a tender bony or cutaneous swelling or tender skin, difficulties arise in fitting a mass-produced brace. In order to overcome these difficulties a carefully moulded made-to-measure halo-shoulder brace and also a mandibular-shoulder brace were developed. The halo-shoulder brace (a halo connected with 4 rods to a shoulder girdle) provides an effective means of postoperatively controlling the unstable cervical spine until the graft unites. The brace is well tolerated by the patient and facilitates early postoperative mobility. The mandibular-shoulder brace (a similar shoulder girdle with a mandibular and an occipital part), also well tolerated by the patient, is used after the halo-shoulder brace during consolidation of the graft and also to support the neck in patients who for other reasons require a collar but who cannot tolerate a normal ready-made appliance. The manufacture of the braces, their effectiveness and a series of 13 patients are described.
Cervical Myelopathy in Rheumatoid Arthritis
