Cervical Spine Involvement Research Articles

285. Cervical Spine Involvement in Jia: A Clinical and Radiological Correlation

285. Cervical Spine Involvement in Jia: A Clinical and Radiological Correlation

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

BackgroundTo describe MRI and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy.Methods13 patients with signs of cervical spine involvement in juvenile idiopathic arthritis with a median disease duration of 1.7 years were included in the study. Clinical records and MR images were retrospectively analyzed according to symptoms and findings concerning the cervical spine.ResultsAt the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI.ConclusionsThis first MRI based follow-up study shows that cervical spine arthritis can follow a severe disease course in juvenile arthritis. While malalignments and inflammation sites decreased osseous changes with erosions, ankylosis, and narrowing of the spinal canal increased under treatment despite only minor subjective complaints. Therefore close MRI monitoring of these patients appears to be reasonable.

A87: Different Tocilizumab Therapeutic Protocols and Possibility Achieving Tocilizumab‐Off Remission in Systemic Juvenile Idiopathic Arthritis

Background/Purpose:Systemic juvenile idiopathic arthritis (SJIA) is one of the most striking forms of juvenile arthritis, required biologics due to failure of corticosteroids (CS) and DMARDs. In Russia until March 2013 no Il‐1 blockers were available. Since tocilizumab (TCZ) was approved in adults with rheumatoid arthritis we used it for treatment of SJIA.The aim of our study was to evaluate outcomes and to find possible criteria, related with different treatment TCZ protocols and achievement TCZ‐off remission.Methods:our retrospective study was included 33 active SJIA children who fall CS, methotrexate (MTX), cyclosporine A (CsA) and their combination. We used TCZ in 2 branches in standard doses: every 2 (Q2W) or every 4 weeks (Q4W). The randomization was based on efficacy which was evaluated in 14th day. If patient had no signs of TCZ inefficacy during next 2 weeks (days 15–29) the patient was referred to Q4W group (n=24), if any clinical or laboratorial signs of inefficacy during first 4 weeks were occurred the patient was treated Q2W (n=9). The protocol of this trial was approved by local Ethic Committee of our University. The term “efficacy” means at least ACR70 improvement and absence of systemic features.Results:The main demographic parameters (Me;IQR) included the age‐10.2 (6.0–12.75) years and delay of TCZ‐36.0 (11.2–97.0) months. Treatment before TCZ were CS‐31 (93.9%), MTX‐29 (87.9%), CsA‐16 (48.5%) and their combination. The macrophage activation syndrome (MAS) before TCZ was in 8 (24.2%). During the trial CS successfully discontinued 19/31 (61.3), CsA 9/16 (56.3%), MTX 8/29 (27.6%) patients. In 5 children TCZ was discontinued due to stable remission with median duration 640 days (3/5 remission off‐medication, 2/5 still on MTX). After TCZ initiation 4 children have experienced MAS, but all of them had MAS before TCZ, so no “new cases” were observed on TCZ. 3 children early withdrew during the trial due to adverse events (infusion reaction, MAS) and 1 child died (severe uncontrolled MAS). Patients which were treated every 4 weeks had milder SJIA course compare with Q2W (table ). Factors, related with milder SJIA course and allowed to use Q4W TCZ were: Hb>10.3 g/dl (p=0.00001), WBC ≤12.6*109/l (p = 0.013), granulocytes ≤8556 cells/μl (p = 0.00037), CRP ≤82.2 mg/l (p = 0.002), ESR ≤26 mm/h (p = 0.02), ferritin ≤605 mg/ml (p = 0.0001) before start of TCZ and granulocytes in 1 week after 1st TCZ ≤8142 cells/μl (p = 0.014). Criteria, associated with TCZ‐off remission were: absence of knee (p = 0.045) and cervical spine involvement (p = 0.03), number of active joints ≤12 (p = 0.05), ESR ≤40 mm/h (p = 0.05), total protein ≤6.6 g/dl (p = 0.04) at the moment of 1st TCZ infusion and granulocytes in 2 week ≤2907/μl (p = 0.038), WBC in 4 week ≤6300/μl (p = 0.026) after 1st TCZ. Parameters Q2W (n = 9) Q4W (n = 24) p Hemoglobin, g/dl 9.8 (9.6–10.3) 11,5 (10,9–13,1) 0,003 Anemia, n (%) 8 (88.9) 10 (41,7) 0,02 WBC,109/l 17.2 (13.6–20.8) 9,5 (7,65–13,2) 0,016 Granulocytes, cells in 1 μl 13728 (11424–18382) 6318 (4822–8184) 0,005 Granulocytes in 1 week, cells 1 μl 8944 (6560–12375) 3314 (1840–7240) 0,015 CRP, mg/l 84.5 (20.6–104.8) 17.6 (6.7–74.5) 0.025 ESR, mm/h 45.0 (42.0–61.0) 25.0 (10.5–47.5) 0.016 Ferritin, mg/ml 858.0 (326.0–1859.0) 128.0 (48.5–238.0) 0.004 LDH, U/l 714.0 (655.5–792.5) 464.0 (360.0–513.0) 0.02 Total protein, g/dl 6.6 (6.2–6.9) 7.1 (6.8–7.7) 0.003 Albumin, g/dl 2.1 (1.7–2.6) 3.1 (2.9–3.3) 0.002 Hepatomegaly 8 (88.9) 9 (37.5) 0.017 Coagulopathy 3 (33.3) 0 (0.0) 0.015 Interstitial lung disease 4 (44.4) 1 (4.2) 0.013 CNS dysfunction 5 (55.6) 0 (0.0) 0.001 Knee arthritis 2.0 (2.0–2.0) 1.5 (0.0–2.0) 0.02 Knee arthritis, n (%) 9 (100.0) 14 (58.3) 0.03 MAS before TCZ 4 (44.4) 4 (16.7) 0.17 MAS during TCZ 4 (44.4) 0 (0.0) 0.003 TCZ efficacy, n (%) 6 (66.7) 23 (95.8) 0.05 SJIA relapses 4/9 (44.4) 1 (4.2) 0.013 TCZ discontinuation. due to: 3 (100.0) 6 (100.0) 0.038 ‐remission 0/3 (0.0) 5/6 (83.3) ‐infusion reaction 0/0 (0.0) 1/6 (16.7) ‐MAS + infusion reaction 2/3 (66.7) 0/6 (0.0) ‐MAS → death 1/3 (33.3) 0/6 (0.0) Me (IQR), Fisher's exact testConclusion:We found clinical and laboratorial criteria for mild/moderate SJIA allowed to use TCZ Q4W and provisional criteria, related to achievement TCZ‐off remission.

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

ObjectiveTo clarify the incidence and predictive risk factors of cervical spine instabilities which may induce compression myelopathy in patients with rheumatoid arthritis (RA).MethodsThree types of cervical spine instability were radiographically categorized into “moderate” and “severe” based on atlantoaxial subluxation (AAS: atlantodental interval >3 mm versus ≥10 mm), vertical subluxation (VS: Ranawat value <13 mm versus ≤10 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm versus ≥4 mm or at multiple). 228 “definite” or “classical” RA patients (140 without instability and 88 with “moderate” instability) were prospectively followed for >5 years. The endpoint incidence of “severe” instabilities and predictors for “severe” instability were determined.ResultsPatients with baseline “moderate” instability, including all sub-groups (AAS+ [VS− SAS−], VS+ [SAS− AAS±], and SAS+ [AAS± VS±]), developed “severe” instabilities more frequently (33.3% with AAS+, 75.0% with VS+, and 42.9% with SAS+) than those initially without instability (12.9%; p<0.003, p<0.003, and p = 0.061, respectively). The incidence of cervical canal stenosis and/or basilar invagination was also higher in patients with initial instability (17.5% with AAS+, 37.5% with VS+, and 14.3% with SAS+) than in those without instability (7.1%; p = 0.028, p<0.003, and p = 0.427, respectively). Multivariable logistic regression analysis identified corticosteroid administration, Steinbrocker stage III or IV at baseline, mutilating changes at baseline, and the development of mutilans during the follow-up period correlated with the progression to “severe” instability (p<0.05).ConclusionsThis prospective cohort study demonstrates accelerated development of cervical spine involvement in RA patients with pre-existing instability—especially VS. Advanced peripheral erosiveness and concomitant corticosteroid treatment are indicators for poor prognosis of the cervical spine in RA.

In vivo 3D kinematics of the upper cervical spine during head rotation in rheumatoid arthritis

The upper cervical spine is commonly involved in persons with rheumatoid arthritis (RA). Although 2D measurements have long been used in the evaluation of cervical lesions caused by RA, 2D measurements are limited in their effectiveness for detecting subtle and complex morphological and kinematic changes. The purpose of this study was to elucidate the 3D kinematics of the upper cervical spine in RA and the relationship between 3D morphological changes and decreased segmental rotational motion. Twenty-five consecutive patients (2 men and 23 women, mean age 63.5 years, range 42-77 years) with RA (the RA group) and 10 patients (5 men and 5 women, mean age 69.9 years, range 57-82 years) with cervical spondylosis and no involvement of the upper cervical spine (the control group) underwent 3D CT of the cervical spine in 3 positions (neutral, 45° head rotation to the left, and 45° head rotation to the right). The segmental rotation angle from the occiput (Oc) to C-2 was calculated for each participant using a voxel-based registration method, and the 3D destruction of articular facets was quantified using the authors' own parameter, the articular facet index. The segmental rotation angle was significantly smaller at C1-2 and larger at Oc-C1 in the RA group compared with the control group. The degree of the destruction of the articular facet at C-1 and C-2 correlated with the segmental rotation angle. In vivo 3D kinematics of the upper cervical spine during head rotation in patients with RA were accurately measured, allowing quantification of the degree of joint destruction for the first time. Joint destruction may play an important role in decreasing segmental motion of the upper cervical spine in RA.

Psoriatic spondylitis

A 43-year-old man presented to the clinic with neck pain and stiffness. He denied any back or radicular pain. He had a long history of psoriasis and suffered multiple peripheral joint pain and stiffness that included the elbow, knee, and distal interphalangeal joints. Spondyloarthritis can be a manifestation of psoriatic arthritis but is rarely present without peripheral joint involvement. Cervical spine imaging displayed cervical apophysial joint ankylosis, the most common spine pathology found in psoriatic arthritis, without ligamentous calcification (Fig. 1, Fig. 2, Fig. 3). Imaging of the lumbar spine did not reveal any of the typical changes of ankylosing spondylitis. The localization of changes to the cervical spine and lack of ligamentous calcification helps to differentiate between psoriatic arthritis and ankylosing spondylitis [ 1 Bobek D. Babić-Naglić D. Potocki K. et al. The cervical spine involvement in patients with psoriatic arthritis. Reumatizam. 2007; 54: 12-15 PubMed Google Scholar , 2 Helliwell P.S. Taylor W.J. Classification and diagnostic criteria for psoriatic arthritis. Ann Rheum Dis. 2005; 64: 3-8 PubMed Google Scholar , 3 Gladman D. Psoriatic arthritis. Baillieres Clin Rheumatol. 1995; 9: 319-329 Abstract Full Text PDF PubMed Scopus (62) Google Scholar ]. Fig. 2CT midsagittal and parasagittal images showed complete ankylosing of the subaxial facet joints sparing the anterior and posterior longitudinal ligaments. CT, computed tomography. View Large Image Figure Viewer Download Hi-res image Fig. 3CT scan axial image of the axial spine showed complete ankylosing of the occiput–C2 joints. CT, computed tomography. View Large Image Figure Viewer Download Hi-res image

Gout initially mimicking rheumatoid arthritis and later cervical spine involvement.

Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA). We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications.

Surgical Management of the Atlantoaxial Instability in Rheumatoid Arthritis: A Series of 28 Patients with 10 Years of Follow Up

It is known that cervical spine involvement occurs in over half of patients with rheumatoid arthritis (RA). This involvement is over 70% in Tunisia. The majority of our patients are seen at Ranawat’s stage III with spinal cord injury. We report a series of 28 patients treated in our institution for RA with atlantoaxial dislocation with several degrees of spinal cord injury (Ranawat’s stage II and III). Even though overshadowed by major impairments related to severe peripheral joint disease, 60% of our patients presented a good functional result at the average of 10 years follow up.

Early Symptomatic Cervical Spine Involvement in an Infant with Polyarticular Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis, a spectrum of chronic arthritis in children may involve the cervical spine, though it is not as common as in rheumatoid arthritis in adults. Many children may remain asymptomatic.MRI should be done, even if asymptomatic, to detect early changes and aggressive treatment started. Early symptomatic cervical spine involvement is quite rare in children with JIA.

Cervical spine involvement early in the course of rheumatoid arthritis

ObjectivesCervical spine involvement in rheumatoid arthritis (RA) is considered a feature of long-standing disease. We describe two patients who presented with cervical symptoms as early features of RA. MethodsWe report two RA cases with cervical spine involvement as early features and use MEDLINE to review the literature concerning the frequency and disease duration of this manifestation and its imaging with plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). ResultsAn 80-year-old man with cervical myelopathy from a C1–C2 rheumatoid pannus underwent decompression surgery before development of peripheral synovitis from RA. A 63-year-old woman presented with neck pain and polyarthritis at RA diagnosis, with imaging that confirmed a C1–C2 rheumatoid pannus. Onset of cervical spine involvement in RA is generally after 10 years of disease duration, ranging from 3 months to 45 years after peripheral synovitis among patients with seropositive erosive RA. Occurring in 9–88% of RA patients, cervical spine involvement may result in cervical instability due to either mechanical compression or vascular impairment of the spinal cord. Bone erosions and atlanto-axial subluxation on standard radiographs are two major signs of cervical spine involvement in RA. MRI identifies earlier signs of RA and has a higher sensitivity in detecting bone erosions compared to conventional radiography. ConclusionsCervical spine involvement in RA is not an uncommon condition but is rare at early disease onset. Symptoms of cervical pain and myelopathy should prompt a thorough neurological examination accompanied by imaging.

PReS-FINAL-2084: Prevalence of cervical spine involvement in children with juvenile idiopathic arthritis

Cervical spine arthritis is a well-recognized complication of juvenile idiopathic arthritis (JIA). It is usually present in patients with more severe disease.

Surgical Treatment of dialysis-associated spondylosis

【Objective】The purposes of this study were to classify the lesions of dialysis-associated spondylosis and evaluate the results of surgical treatment. 【Subjects and methods】The subjects were 87 patients (43 men and 44 women) who underwent surgery. These patients were studied in terms of lesion classification, surgical method, duration of dialysis, duration of surgery, intraoperative blood loss, and postoperative complications. 【Results】Among patients with cervical spine involvement, 13 had destructive spondyloarthropathy (DSA), 29 had amyloid deposition, and 8 had a dens axis lesion. Among patients with lumbar spine involvement, 20 had DSA, and 17 had amyloid deposition. With regard to 6 patients with a dens axis lesion involving atlantoaxial subluxation, each had posterior fusion (PF) of the occiput to the upper cervical spine. With regard to the patients with lumbar DSA, 10 patients had posterolateral fusion (PLF), 8 patients had posterior lumbar interbody fusion (PLIF) and 2 patients had laminectomy. The duration of dialysis in cases of a dens axis lesion varied between 25 and 35 years, with the mean duration being 28.9 years. 【Conclusions】All patients who underwent surgery for dens axis lesions were long-term dialysis patients who had been on dialysis for 25 years. Lumbar spine DSA was treated with PLIF in patients with lateral slipping and marked instability, with laminectomy in patients with a narrowed intervertebral disk space and no instability. ACTA MEDICA NAGASAKIENSIA 56: 5－11, 2011

Atlantoaxial Subluxation in Rheumatoid Arthritis

The first description of the cervical spine involvement in patients with rheumatoid arthritis (RA) dates to 1890 and was made by Sir Archibald Edward Garrod1. RA is the most common inflammatory disease involving the cervical spine2, and anterior atlantoaxial subluxation, resulting from laxity of the primary and secondary ligamentous restraints, is the most common cervical deformity associated with RA3. In February 2013, a 40-year-old white …

Axial calcium pyrophosphate dihydrate deposition disease revealed by recurrent sterile spondylodiscitis and epidural abscess

Spondylodiscitis are frequent and clinical challenge for practionners. Axial calcium pyrophosphate dihydrate deposition disease (CPDD) is well known for cervical spine involvement with the crowned dens syndrome but other localisations are probably underdiagnosed in sterile spondylodiscitis. We report a case of recurrent sterile spondylodiscitis with epidural abscess related to CPDD proved by vertebral percutaneous needle biopsy with rapid favourable course under colchicine therapy. Axial CPDD could mimic septic spondylodiscitis with epidural abscess on MRI. Sterile spondylodiscitis are probably underdiagnosed forms of microcrystalline disease. Investigations of the presence of microcrystals should be systematically undertaken with tamponed formalin fixed biopsies. If axial CPDD is suspected, colchicine therapy could be a good therapeutic test and would avoid unnecessary antibiotic treatment.

Fever of Undetermined Origin: Cervical Diskitis-Osteomyelitis Associated With Esophageal Self-Expanding Metal Stent

Conflicts of interest The authors disclose no conflicts. © 2013 by the AGA Institute 1542-3565/$36.00 http://dx.doi.org/10.1016/j.cgh.2013.05.039 Aof an esophageal self-expanding metal stent (SEMS). She was diagnosed with squamous cell carcinoma of the upper esophagus 6 months previously at another facility. She underwent placement of the partially covered SEMS at that time. She subsequently underwent chemotherapy and radiation therapy, with follow-up positron emission tomography–computed tomography (CT) showing no evidence of residual disease. About 2 weeks after completion of therapy, she started experiencing intolerance to liquids in the form of coughing episodes, followed by onset of fevers. Work-up for fever at the outside facility was unrevealing. Endoscopic removal of the SEMS was unsuccessful, and she was referred to our facility. Upon review of systems, she also reported upper back pain for the past few weeks. A barium esophagogram did not reveal any leak, fistula, obstruction, or perforation. A CT scan of the thorax suggested erosion of the posterior aspect of the SEMS into the C7 and T1 vertebral bodies (Figure A, sagittal CT view). Endoscopic views of the SEMS were unremarkable. The SEMS was removed under general anesthesia using a double-channel therapeutic gastroscope and 2 rat-tooth forceps, with no evidence of perforation noted after stent removal (Figure B). A barium esophagogram obtained after stent removal showed no evidence of a leak or fistula. Subsequent magnetic resonance imaging of the C-spine and T-spine showed enhancement of the C7, T1, T2, and T3 vertebral bodies, suggestive of diskitis-osteomyelitis (Figure C, sagittal T2-weighted magnetic resonance image). Blood cultures were negative. The patient’s fevers abated with appropriate antibiotic therapy. At the last follow-up evaluation 3 months later, she remained asymptomatic without any back pain or fevers. Esophageal SEMS have become an integral part of the management of malignant dysphagia. The patient’s initial symptoms of cough and intolerance to oral intake were suspicious for a tracheoesophageal fistula. However, barium esophagogram before and after stent removal failed to show the same. Her symptoms were likely caused by cervical spine involvement, esophageal dysmotility, and/or reflux. Cases of spondylodiscitis and osteomyelitis associated with esophageal stents, both plastic stents and SEMS, for benign indications as well as malignant indications have been reported previously. Although most cases have occurred in association with overt stent-induced perforation, there was no evidence of perforation in the current case. It is possible that a small perforation may have sealed by the time of fluoroscopic and endoscopic study at our institution. Given the widespread use of SEMS for palliation of dysphagia, clinicians need to be aware of the above described delayed complication associated with their use.

AB1129 Radiological cervical spine involvement in juvenile idiopathic arthritis in adulthood

BackgroundSeveral studies have assessed cervical spine structural involvement in juvenile idiopathic arthritis (JIA) but most of them included only symptomatic patients without differentiating subsets of JIA.ObjectivesTo evaluate the frequency and...

THU0321 110 patients with enthesitis related arthritis: A demographic and clinical study from a tertiary level pediatric rheumatology centre in india

BackgroundThe ERA subcategory forms a major proportion of children with JIA in India (36%) (1) whereas western literature suggests ERA in JIA patients to be 6-19% (2,3). In these patients,...

Gorham disease: a case with severe cervical spine involvement

Gorham disease: a case with severe cervical spine involvement

TGFBR2 gene polymorphism is associated with ossification of the posterior longitudinal ligament

This preliminary study assessed the association between ossification of the posterior longitudinal ligament (OPLL) and the transforming growth factor β receptor type 2 (TGFBR2) gene, with autoimmune disease examined as a possible underlying factor. Twenty-one patients diagnosed with OPLL and 42 control patients without OPLL (non-OPLL) were enrolled in the study. The TGFBR2 gene, composed of one promoter and seven exons, including the 5′ untranslated region and flanking introns of each exon, was sequenced. Laboratory tests, including indirect immunofluorescence, were performed to detect autoimmune antibodies. The most common types of OPLL were the continuous (n=8, 38.1%) and segmental (n=8, 38.1%) types, with the fifth cervical veterbra (C5) the most common level of cervical spine involvement (n=15, 71.4%). In addition, significant associations between 455-4T→A (p=0.007) and 571G→A (p=0.024) gene variation and OPLL were found. The 95-35C→T variation in intron 1, a previously unreported variation, was also found in all patients with OPLL. Four patients revealed positive results for autoimmune antibodies and exhibited a nucleolar pattern by indirect immunofluorescence. Of these four patients, two were diagnosed with Sjogren’s syndrome. The previously reported association of 455-4T→A and 571G→A polymorphisms of the TGFBR2 gene with OPLL was confirmed in this study. In addition, the 95-35C→T polymorphism in intron 1, which to our knowledge is a novel, previously unreported, nucleotide variation, was detected in all patients. Additional functional studies are required to verify the association between OPLL and the genetic variations found in this study.

Unusual presentation of cervical spine metastases to the ENT surgeon

Cervical spine metastases account for 10 per cent of all spinal metastases. We report three cases of cervical spine metastases whose unusual primary presentation was with ENT-related symptoms. The three patients reported herein did not have a confirmed diagnosis of malignancy at presentation. The first patient presented with stridor, the second presented with dysphagia and the third presented with dysphonia. All patients complained of significant neck pain that preceded and was concomitant to the other symptoms. Clinical suspicion of cervical spine involvement led to radiological investigation with computed tomography, which showed metastatic lesions in the craniovertebral junction and cervical spine region. Histological confirmation of malignancy was obtained for two of the three patients. The condition proved uniformly fatal in the weeks following diagnosis. A review of the literature on this condition was conducted using PubMed and Medline databases. Cervical spine pathology may present initially to the ENT surgeon. A high degree of suspicion of cervical spine involvement should be maintained in elderly patients with persistent or progressive neck pain, with or without other ENT symptoms. Adequate radiological imaging will usually confirm the diagnosis.