Abstract
Diameters of anterior and posterior atlantodental intervals (AADI and PADI) are diagnostically conclusive regarding ongoing neurological disorders in rheumatoid arthritis. MRI and X-ray are mostly used for patients' follow-up. This investigation aimed at analyzing these intervals during motion of cervical spine, when transverse and alar ligaments are damaged. AADI and PADI of 10 native, human cervical spines were measured using lateral fluoroscopy, while the spines were assessed in neutral position first, in maximal inclination second, and in maximal extension at last. First, specimens were evaluated under intact conditions, followed by analysis after transverse and alar ligaments were destroyed. Damage of the transverse ligament leads to an increase of the AADI's diameter about 0.65 mm in flexion and damage of alar ligaments results in significant enhancement of 3.59 mm at mean. In extension, the AADI rises 0.60 mm after the transverse ligament was cut and 0.90 mm when the alar ligaments are damaged. After all ligaments are destroyed, AADI assessed in extension closely resembles AADI at neutral position. Ligamentous damage showed an average significant decrease of the PADI of 1.37 mm in the first step and of 3.57 mm in the second step in flexion, while it is reduced about 1.61 mm and 0.41 mm in the extended and similarly in the neutrally positioned spine. Alar and transverse ligaments are both of obvious importance in order to prevent AAS and movement-related spinal cord compression. Functional imaging is necessary at follow-up in order to identify patients having an advanced risk of neurological disorders.
Highlights
Rheumatoid arthritis (RA) is a common chronic, systemic autoimmune disease, affecting an estimated 1-2% of the global population, being three times more frequent in women [1]
Once the transverse ligament was cut, atlantodental interval (AADI) in neutral position of the cervical spine altered to 2.19 mm ± 0.58
AADI was reduced to 2.23 mm ± 0.57 on average
Summary
Rheumatoid arthritis (RA) is a common chronic, systemic autoimmune disease, affecting an estimated 1-2% of the global population, being three times more frequent in women [1]. RA comes along with hypertrophy of the synovial tissue as pannus formation. These inflammatory, symmetric processes occur at peripheral joints, resulting in erosion of the articular cartilage and subchondral bone [2, 3]. The cervical spine represents a predilection site of RA, being the most common inflammatory disorder affecting the spine [2]. Upper cervical spine involvement starts in the early course of disease. Affection of the lower cervical spine, is less common and arises in the later course of disease, manifesting as multilevel dislocation [4]. Previous investigations pointed out that men have major risk of advanced cervical spine involvement [2, 7, 8]
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