Rheumatoid Arthritis of the Craniovertebral Junction

Abstract

Surgical management of RA remains a challenging field. There clearly has been a decrease in cases of mutilating RA involving the craniovertebral junction. Surgical techniques for managing these conditions have steadily improved.

Radiological evaluation of cervical spine involvement in rheumatoid arthritis

“…If any cervical spine disease is suspected or confirmed with plain radiographs or the patient has any neurological symptom or important cervical pain, then CT and/or MRI examination of the cervical spine is indicated. 2,18,26,40 A CT scan with multiplanar reconstruction is the method of choice for detailed bony evaluation (including visualization of erosions, anatomy, and the presence of ankylosis and pseudarthrosis). For this reason, CT is important for surgical planning.…”

“…However, soft tissue evaluation is limited in this imaging modality, and its ability to visualize the spinal cord and the nerve roots is poor. 18,35 Finally, MRI is the most sensitive modality for detection of cervical spine involvement in RA and should be performed in all patients with anomalies detected or suspected on plain radiographs. 45 A cervical MRI study should also be performed in all patients with myelopathy or radiculopathy.…”

“…The normal value of the anterior atlantodental interval (ADI)-the distance from the posterior border of the anterior tubercle of the atlas to the dens-is less than 3 mm in healthy adults 18 ( Fig. 1).…”

“…Multilevel subluxations can produce a "staircase" deformity, associated with severe systemic RA. 18,22,27 In this paper, we review and discuss the limitations and benefits of each radiological method used to diagnose cervical instability, as well as the criteria used to classify the most common forms of cervical spine involvement in RA.…”

5 Biomechanics of the Craniovertebral Junction

“…This condition, known as basilar impression, is hallmarked by translation of the odontoid process in the cranial direction and subluxation or dislocation of the atlanto-occipital joint (Martin et al, 2010). Additionally, an odontoid pannus often develops, which has the potential to compress the spinal cord (Krauss et al, 2010). A recent study using computed tomography (CT) of patients with rheumatoid arthritis in the cervical spine reported instability in sagittal translation in a large percentage of patients.…”