Cranial settling in rheumatoid arthritis.

el-Khoury, G Y; Wener, Mark H.; Menezes, Arnold H.; Dolan, Kathleen; Mh, Kathol

doi:10.1148/radiology.137.3.7444048

Cited by 45 publications

(15 citation statements)

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“…15 Cranial settling or atlantoaxial impaction (AAI) is another serious complication of long-standing rheumatoid arthritis. [20][21][22][23] This occurs when the skull and C1 (first vertebrae) begin to settle down on the cervical spine, and the commonly eroded odontoid process comes to lie at an abnormally high location, often severely impinging the brainstem or the craniovertebral junction. Some believe the resultant compression of the medulla and vertebral arteries is the reason for sudden death among patients with rheumatoid arthritic patients who experience cranial settling.…”

Section: Introductionmentioning

confidence: 99%

Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

Kjellberg¹,

Pavlou²

2011

The Angle Orthodontist

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Objective: To evaluate whether plain lateral cephalometric radiographs in the neutral position could be used as a diagnostic tool to investigate changes in the cervical spine related to juvenile idiopathic arthritis (JIA). Materials and Methods: Lateral cephalometric radiographs of 82 subjects, 21 males and 61 females (8-25 years old), affected with JIA were revised and compared with 82 healthy control subjects matched in age and gender. Changes inspected in the cervical spine were erosions of the dens and fusion of the apophyseal joints. Anterior atlantoaxial subluxation of the first vertebra in relation to the second was examined by measuring the anterior atlanto-dens interval (aADI). Atlantoaxial impaction (AAI) was studied by using the Sakaguchi-Kauppi method.

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Section: Introductionmentioning

confidence: 99%

Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

Kjellberg¹,

Pavlou²

2011

The Angle Orthodontist

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“…A partial collapse of the atlantoaxial facet-joint complexes results in a cranial subluxation of the odontoid process into the foramen magnum. This process of progressive contact of the odontoid peg with the medulla is known as cranial settling when occurring as a result of rheumatoid disease (El-Khoury et al 1980). Identification of the onset of cranial settling is especially important, as it serves as a surrogate marker for patients prone to poorer outcome (Sherk 1978).…”

Section: Biomechanics Of the Upper Cervical Joints And The Influence mentioning

confidence: 99%

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

Murphy¹,

McEvoy²,

Bolger³

2012

Rheumatoid Arthritis - Etiology, Consequences and Co-Morbidities

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“…This involvement of the occipito-atlantal articulation corresponds to the third stage and has also been described as cranial settling [14]. Subaxial subluxation, which also represents a late phenomenon of the disease, is due to erosions of the facet joints along with inflammatory destructive changes in the intervertebral disc.…”

Section: Introductionmentioning

confidence: 95%

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Kandziora

Mittlmeier

Kerschbaumer

1999

European Spine Journal

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Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre-and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 ± 19.3 months (range 21-96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P < 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3°± 7.8°for rotation; 7.8°± 5.6°for bending; average gain of motion in group II: 21.5°± 14.0°f or rotation; 17.2°± 5.5°for bending), while it decreased significantly in group III (10.7°± 18.1°for rotation; 6.7°± 18.5°for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.Key words Atlanto-axial instability · Transoral approach · Decompression · Rheumatoid arthritis · C1/C2 fusion ORIGINAL ARTICLE Eur Spine J (1999) 8 : 371-381

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Cranial settling in rheumatoid arthritis.

Cited by 45 publications

References 0 publications

Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

Stage-related surgery for cervical spine instability in rheumatoid arthritis

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