Learning objectives
Involvement of thecervicalspineinrheumatoid arthritiscan be essential regarding prognosis and mortality.
Cervicalmyelopathy due to pannus formation and/or subluxation can be fatal.
The aim of thisstudywas toillustrate the possible changes seen by Radiographs,
CT and MRI,
and to establish a risk-profile for the individual patient.
Background
UPPER CERVICAL LIGAMENTS (fig 1)
Transverse ligament of the atlas runs posterior to the dens and attaches to the lateral tubercles of the atlas bilaterally
Synovial capsule is attached between the odontoid process and the transverse ligament.
Tectorial membrane and epidural fat are located dorsal to the transverse ligament
Alar ligament extends from the posterolateral aspect of the apex of the dens horizontally and laterally to the medial side of the occipital condyle
RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a chronic systemic inflammatory disorder affecting multiple...
Imaging findings OR Procedure Details
Three characteristic patterns of subluxation have been described :
•Atlanto axial subluxation
•Cranial settling
•Subaxial subluxation
Atlanto axial subluxation is the most common deformity.
It results from laxity of the primary and secondary ligamentous restraints.
Cranial settling results from occipito atlanto axial erosion and may lead to brainstem compression.
Subaxial cervical subluxation occurs secondary to combined destruction of disco vertebral complex and facet joints.
It may appear as an isolated deformity or affect multiple levels
Radiographs (lateral flexion / extension dynamic views) should be performed...
Conclusion
Radiographs of the cervical spine should be performed initially and periodically thereafter.
Dynamic cervical radiographs should be performed prior to any intervention to rule out instability.
MRI is a valuable method to identify RA patients at risk of developing neurological deficits.
References
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Cervicalspineinvolvement inrheumatoid arthritis--a systematic review.
Autoimmun...