Rheumatoid Arthritis
- cervical spine is severely affected in 30% of rheumatoid patients
- Three types of lesion (instability) are common;
- Erosion of the atlanto-axial joints & the transverse ligament with resulting instability
- Erosion of the atlanto-occipital articulations allowing the odontoid to ride up into the foramen magnum
- Erosion of the facet joints in the mid cervical region which may result in ankylosis but usually instability & subluxation
Clinically
- Usually a women with advanced rheumatoid disease
- Has neck pain & may support her head in her hands & have marked restriction of movement
- Symptoms & signs of root or cord compression may appear in the upper & lower limbs (cervical myelopathy)
X-Rays
- Atlanto-axial instability is evident in the lateral view when taken in flexion & extension (greater than 5mm gap * sig instability)Lateral views, tomograms or now MRI show the relationship of the dens to the foramen magnum
- Flexion views show subluxation in the mid cervical region
Treatment
- Despite the X-Ray appearance serious neurological complications are rare
- Symptomatic relief can usually be achieved by wearing a collar & with anti-rheumatic medication
- Spinal fusion may be indicated if the disability is severe or there is progressive neurological involvement (occipito-cervical, Gallie or mid cervical fusion may be indicated)
Webpage Last Modified:
18 February, 2010