Cervical Spine In Rheumatoid Arthritis Research Articles

Three-dimensional motion of the upper cervical spine in rheumatoid arthritis.

Rheumatoid arthritis frequently contributes to instability of the upper cervical spine. Rotational instability of the upper cervical spine was evaluated in rheumatoid arthritis patients using biplanar x-ray photogrammetry. Three-dimensional cervical motion and the instantaneous axis of rotation of the atlas relative to the axis were evaluated in normal and rheumatoid arthritis patients during axial rotation in the horizontal plane. Anterior atlantoaxial subluxation did not increase during axial head rotation in either the atlantoaxial subluxation or the vertical subluxation groups, while the instantaneous axes of rotation were distributed posteriorly in the dens in the RA-normal group, but were widely scattered in the atlantoaxial subluxation group.

Principles of surgical treatment of the cervical spine in rheumatoid arthritis

About 20% of patients with rheumatoid arthritis complain about neck problems based on instability and deformity. As a consequence, pain, myelopathy, and severe neurological deficit may occur. Results reported in the literature were not encouraging as regards surgical decompression and stabilization. However, new surgical techniques allow a more aggressive strategy towards the complex problem of the instable cervical spine in rheumatoid arthritis. The most frequent instability of C1/2 can be stabilized by a posterior atlantoaxial screw fixation, a three-dimensional multidirectional construct with few complications. For the inclusion of the occiput into the fusion and the extension of the fusion down to the lower cervical spine, a titanium Y-plate is presented as a successful implant. While through a posterior approach, stability may be achieved, decompression is preferably done by anterior diskectomy or vertebrectomy. Encouraging results with a significant recovery of neurological deficits justify an early intervention in cases of instability of the cervical spine in rheumatoid arthritis.

Posterior Stabilization of the Cervical Spine in Rheumatoid Arthritis

Thirteen patients with atlantoaxial dislocation(s) had posterior stabilization and were evaluated clinically with magnetic resonance (MR) imaging and conventional radiography both pre- and postoperatively. Cases with anterior instability had large periodontoid granulomatous pannus formation, but this was lacking in cases with fixed cranial settling. The pannus caused cord compression in four cases and occupied the entire anterior subarachnoid space in four other cases. After stabilization, the granuloma decreased in size in all patients and in four cases it vanished completely. Major signs of myelopathy corresponded to cord compression at MR imaging. Minor possible signs of neural deficit were found in seven cases and their importance was not clearly understood before surgery, but because all preoperative symptoms disappeared, it was necessary to check for even obscure signs as early warnings of a threatening myelopathy.

Posterior Stabilization of the Cervical Spine in Rheumatoid Arthritis

Thirteen patients with atlantoaxial dislocation(s) had posterior stabilization and were evaluated clinically with magnetic resonance (MR) imaging and conventional radiography both pre- and postoperatively. Cases with anterior instability had large periodontoid granulomatous pannus formation, but this was lacking in cases with fixed cranial settling. The pannus caused cord compression in four cases and occupied the entire anterior subarachnoid space in four other cases. After stabilization, the granuloma decreased in size in all patients and in four cases it vanished completely. Major signs of myelopathy corresponded to cord compression at MR imaging. Minor possible signs of neural deficit were found in seven cases and their importance was not clearly understood before surgery, but because all preoperative symptoms disappeared, it was necessary to check for even obscure signs as early warnings of a threatening myelopathy.

Operations for the unstable cervical spine in rheumatoid arthritis

Sixteen patients with seropositive rheumatoid arthritis were operated on for subaxial subluxations. Four of the patients had slight, but progressive, tetraparesis, and 5 had severe or total tetraparesis; they were operated on 1-4 months after the first signs. Seven patients were treated for severe neck and shoulder pain. Nine patients had subluxation at the C3-4 level, the most common site, and 3 patients also had an atlantoaxial subluxation. Patients with cord compression were treated with posterior laminectomies and fusions that relieved the tetraparesis. Two patients died during the early postoperative period: 1 of a cardiac infarction and the other of pneumonia. During 4 (1.5-9) years' follow-up, 3 patients had new subluxations at other levels.

Involvement of the cervical spine in rheumatoid arthritis.

Description des atteintes possibles (subluxation anteroposterieure atloidoaxoidienne, lesions des facettes articulaires laterales des premieres et deuxiemes vertebres cervicales et de l'articulation atlantooccipitale…). Les techniques d'imagerie medicale permettant le diagnostic sont presentees, ainsi que les complications et le traitement de ces lesions

ＲＡ下位頚椎病変のＸ線学的検討 上位頚椎固定術を行った症例を中心に

Radiographic studies of the lower cervical spine in rheumatoid arthritis (RA) were performed to investigate the influence of the fusion of the upper cervical spine upon the lower. Twenty of 54 patients treated operatively were examined. Fourteen cases with atlanto-axial anterior subluxation were treated with McGraw's procedure and 6 cases with atlanto-axial vertical subluxation were treated with occipito-atlanto-axial fusion. Normal subjects of control were 50 patients who were diagnosed as classical RA and treated conservatively.In each case, narrowing of intervertebral space without osteophyte, end-plate erosion, facet erosion, collapse of vertebral body and anterior subluxation were investigated from four roentgenograms (anteroposterior, lateral including neutral, flexion and extension). Collapse and anterior subluxation were more frequently by seen in cases of occipito-atlanto-axial fusion than in cases of McGraw's procedure and non-operative treatment. This result suggests that the fixation of occipitoatloid joint adds great force to the lower cervical spine.

Stabilization of the unstable upper cervical spine in rheumatoid arthritis.

We present our clinical experience and the results of surgical treatment of 13 patients with rheumatoid involvement of the cervical spine, namely severe atlanto-axial dislocation. A posterior fusion was carried out using a bicortical H-shaped iliac crest bone graft and steel wire. Postoperatively all patients were immobilized for 8 weeks in a Halo cast. There were no postoperative complications and all patients showed a stable fusion confirmed by radiography. Complete pain relief was obtained in 9 patients, partial in 4.

Cervical Spine in Rheumatoid Arthritis

Cervical Spine in Rheumatoid Arthritis

The course of atlanto-axial involvement and disc narrowing of the cervical spine in rheumatoid arthritis.

In 188 patients with rheumatoid arthritis 585 radiological examinations of the cervical spine were performed. Subluxation of C1-2 was found more often than expected; it was often the only radiological change in that segment, and its degree was not related to the duration of the disease. Lateral radiographs taken in full flexion were important for the diagnosis. Age over 40 years at the onset of RA, increased ESR at least on one occasion and seropositivity were related to more severe degrees of involvement. The presence of subcutaneous nodules, high titres of the Rose-Waaler reaction and the presence of antinuclear antibodies had no definite relation to the degree of involvement.

The Cervical Spine in Rheumatoid Arthritis

Of 53 severely rheumatoid patients, 43% had cervical spine involvement, Six major categories were found: a) C1-C2 subluxation; b) serial subluxation; c) upward translocation of the odontoid; d) odontoid erosion; 3) apophyseal joint fusion; and f) miscellaneous findings of osteoporosis, endplate erosion, and disk space narrowing without osteophytosis. Although disease duration and activity appeared to correlate somewhat with the development of cervical spine disease, this was by no means universal. Rheumatoid cervical spine disease may be dangerous even in the absence of clinical signs and symptoms. It is therefore recommended that the cervical spine be evaluated in patients with severe rheumatoid disease before general anesthesia is scheduled irrespective of cervical spine complaints recorded in the chart.

Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis

In rheumatoid arthritis spontaneous subluxation of cervical vertebrae is not infrequent and can usually be managed by conservative treatment. Surgical treatment, however, is necessary when there is neural involvement. Of twelve patients who had spine fusion for atlanto-axial subluxation only six had solid union. When conservative treatment fails, reduction by halo traction and arthrodesis of the cervical spine is the method recommended, but the best method of post-operative care remains uncertain. In these patients postoperative immobilization was provided by various methods, including a halo cast or brace, but no method appeared to be superior.

Abnormal Findings of The Cervical Spine in Rheumatoid Arthritis

X-ray examination of the cervical spine were performed on twenty-one hospitalized patients and fourty-two ambulatory patients complaining of neck pains with rheumatoid arthritis. Abnormal atlanto-odontoid separation was found in twenty-four patients and pseudo-basilar impression in thirteen. One of them showed maximum upward transposition of the dens of 10mm above Macgregor's baseline. In addition subluxation of subaxial levels, endoplate erosions and erosions of apophyseal joint were found frequently at the level of C2-3 to C4-5. Atlantoaxial posterior fusion by R. W. McGraw was carried out on a case suffering from severe occipital pain and trigeminal neuralgia associated with sublu xation of the atlano-axial joint on March 15 1974. Three months after operation she had relieved of occipital pain and hyperalgesia on limb and trunk.

Treatment of dislocations in the cervical spine in rheumatoid arthritis and ankylosing spondylitis complicated by signs of cord compression.

Treatment of dislocations in the cervical spine in rheumatoid arthritis and ankylosing spondylitis complicated by signs of cord compression.

Fatal Subaxial Dislocation of Cervical Spine in Rheumatoid Arthritis

Fatal Subaxial Dislocation of Cervical Spine in Rheumatoid Arthritis

Cervical spondylitis in rheumatoid disease: A Comment on neurologic significance and pathogenesis

Involvement of the cervical spine in rheumatoid arthritis can lead to neurologic complications which may go unrecognized in the presence of severe arthritic disease. Described herein is a patient in whom quadriparesis developed gradually and in whom the effects of the vertebral lesions were documented by arteriography and myelography ; the importance of thorough roentgenologic evaluation of these patients is emphasized. Theories as to the pathogenesis of the vertebral lesions are discussed, including the possibility that a “neuropathic effect” may be more important in this disease than has been realized.

Atraumatic Subluxation and Dislocation of the Cervical Spine in Rheumatoid Arthritis

Atraumatic Subluxation and Dislocation of the Cervical Spine in Rheumatoid Arthritis

RHEUMATOID ARTHRITIS OF CERVICAL SPINE.

Patients with rheumatoid arthritis frequently have involvement of the cervical spine. The spectrum of clinical consequence ranges from no symptoms to severe neck pain, quadriparesis, or even death. The pathological changes include rheumatoid pannus and proliferating granuloma involving bone, ligaments, discs, muscles, and tendons of the cervical spine and skull.2,4,14Radiological characteristics are gross cervical spine subluxations, narrow disc spaces, erosions, and osteoporosis. Rheumatoid arthritis of the cervical spine may occur without clinical or radiologic signs of the disease elsewhere.13 Present Study This study is an analysis of 100 cases of definite or classic rheumatoid arthritis according to the American Rheumatism Association criteria.1Clinical, radiologic, and serologic characteristics were determined with special emphasis on radiologic evidence of rheumatoid lesions of the cervical spine. Ten radiologic criteria for diagnosis of rheumatoid arthritis of the cervical spine were used (Table 1). Fig 1-3 illustrate examples of the criteria. All

Changes in the cervical spine in rheumatoid arthritis with compression of the cord; with reports of four cases.

Changes in the cervical spine in rheumatoid arthritis with compression of the cord; with reports of four cases.