Apparent diffusion coefficient as an indicator of spinal cord compression due to anterior atlanto-axial subluxation in rheumatoid arthritis patients

Abstract

The aim of this retrospective study was to evaluate the apparent diffusion coefficient (ADC) as a potential parameter of spinal cord damage in cervical spine instability at the atlanto-axial level in rheumatoid arthritis (RA) patients. Methods One hundred and six RA patients were included in the study. MRI examinations were performed with 1.5T scanner. The ADC was measured at six locations in the cervical spinal cord at the height of the first six cervical vertebrae (from C-1 to C-6). The ADC values were assessed in 2 groups: with and without anterior atlanto-axial subluxation (AAS) diagnosed on plain radiographs. Correlations between ADC values and radiographic measurements and RA activity indicators were evaluated. ResultsThe ADC values at C1 level (ADC 1 ) was higher in the group with anterior AAS than in the group without AAS (p < 0.001). Statistically significant moderate positive correlation between ADC 1 and anterior atlanto-axial diameter interval AADI (rho = 0.58; p < 0.008) was found as well as statistically significant weak negative correlation between ADC 1 and posterior atlanto-axial diameter interval PADI (rho = − 0.34; p < 0.008). Conclusions The conducted study demonstrates the applicability of the ADC maps in the identification of spinal cord compression due to anterior AAS in RA patients. The results encourage the practical use of the ADC as an additional parameter in the qualification for surgical treatment.

Radiological Evaluation of Cervical Spine Involvement in Rheumatoid Arthritis: A Cross-Sectional Retrospective Study

“…Recently, apparent diffusion coefficient (ADC) allows the early identification of cervical cord pathologies in patients with anterior AAS and normal MRI. This parameter may be useful for spinal surgery qualification [ 34 ]. Compared to a control group of patients with osteoarthritis, there were no statistically significant differences in prevalence of spinal stenosis, cervical cord compression, cervical myelopathy, and brain stem compression between patients with RA and osteoarthritis.…”

Cervical spine instability and canal stenosis caused by rheumatoid arthritis

“…The pannus will disappear after an immobilization of the atlantoaxial segment, and no progression of the upward migration of the dens despite the unchanged systemic course of the disease during the 5year follow-up. 12 And there were no significant increase in the Redlund-Johnell index too. 16 Early atlantoaxial fusion seemed to…”

“…Once it turns to myelopathy, 50% will die in a year. 12 In this case report, we describe a successfully managed patient with rheumatoid arthritis who developed erosive destruction of the odontoid process, anterior atlantoaxial subluxation, superior migration of odontoid, sub-axial subluxation, and cervical canal stenosis. Stenosis at level C34 that occurs due to anterior listhesis C3 to C4, which can be exacerbated by flexion-extension movements.…”

“…11 Essential discussions have existed about the management in patients whom radiologically confirmed cervical instability in the absence or mild neck pain and neurological symptoms. 12 To avoid unnecessary surgery, some of the authors accept conservative management, cervical orthosis, and symptomatic treatment. This option may lead to late interventions, which has proved to make a worse outcome.…”

Imaging update in inflammatory arthritis

“…37,38 DWI may be also useful in detecting early spinal cord damage. New research found 39 that ADC value at the level of the 1st vertebra was significantly higher in rheumatoid patients with atlanto-axial instability than in the group without instability, despite the lack of signal changes in standard MR images (Fig. 6).…”