Rheumatoid arthritis in the cervical spine.
Publication/Presentation Date
11-1-2005
Abstract
The cervical spine often becomes involved early in the course of rheumatoid arthritis, leading to three different patterns of instability: atlantoaxial subluxation, atlantoaxial impaction, and subaxial subluxation. Although radiographic changes are common, the prevalence of neurologic injury is relatively low. The primary goal of treatment is to prevent permanent neurologic injury while avoiding potentially dangerous and unnecessary surgery. Strategies include patient education, lifestyle modification, regular radiographic follow-up, and early surgical intervention, when indicated. Magnetic resonance imaging is indicated when neurologic deficit (myelopathy) occurs or when plain radiographs show atlantoaxial subluxation with a posterior atlantodental interval < or =14 mm, any degree of atlantoaxial impaction, or subaxial stenosis with a canal diameter < or =14 mm. Surgery should be considered promptly for any of the following: progressive neurologic deficit, chronic neck pain in the setting of radiographic instability that does not respond to nonnarcotic pain medication, any degree of atlantoaxial impaction or cord stenosis, a posterior atlantodental interval < or =14 mm, atlantoaxial impaction represented by odontoid migration > or =5 mm rostral to McGregor's line, sagittal canal diameter < 14 mm, or a cervicomedullary angle < 135 degrees.
Volume
13
Issue
7
First Page
463
Last Page
474
ISSN
1067-151X
Published In/Presented At
Kim, D. H., & Hilibrand, A. S. (2005). Rheumatoid arthritis in the cervical spine. The Journal of the American Academy of Orthopaedic Surgeons, 13(7), 463–474. https://doi.org/10.5435/00124635-200511000-00006
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
16272271
Department(s)
Administration and Leadership
Document Type
Article