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PubMedDate not supplied

Magnetic resonance imaging for the study of cervical myelopathy in rheumatoid arthritis.

Cervical myelopathy is found fairly often with rheumatoid arthritis. It is one of the worst complications of the disease and can lead to tetraplegia or even to sudden death. However, when we consider the high incidence of involvement of the cervical spine in rheumatoid arthritis, the number of cases of cervical myelopathy, even of slight degree, is not very high. We have used magnetic resonance to identify the condition of the cervical structures, especially the nerve structures, in 15 patients with rheumatoid arthritis, with involvement of the cervical articulations but without neurological symptoms. We found anterior compression of the spinal cord caused by the odontoid process of the epistropheus in 13 cases. One case had lateral deviation of the spinal cord and another had compression of a vertebral artery. In another the lumen of the nasopharynx was decreased and one had posterior compression of the spinal cord by the posterior arch of the atlas. Magnetic resonance also makes it possible to detect a rheumatoid pannus on the affected articulations. We conclude that magnetic resonance is at present a useful instrument for evaluation of the presence of cervical myelopathy in rheumatoid arthritis patients, to prevent more serious complications.

Adult↗
PubMed1988

Atlantoaxial facet joint arthritis in the rheumatoid cervical spine. A panoramic zonography study.

Twenty-three patients with severe, longterm (22 years, range 8-36) rheumatoid arthritis were evaluated for rheumatoid changes in the atlantoaxial facet joints using a panoramic zonography program. Ten patients had vertical subluxation of the odontoid process. In 9 of 10 cases this mode of subluxation was associated with grade 3-4 arthritis in the facet joints. Our findings indicate atlantoaxial facet joint arthritis with bilateral collapse of the lateral facet joint masses as a cause of vertical subluxation. Furthermore, we suggest that panoramic zonography investigation is a valuable contribution to the pattern of radiographic examination of the atlantoaxial facet joint arthritis, especially for evaluation of its clinical counterparts: nonreducible lateral head tilt and vertical atlantoaxial subluxation.

Arthritis, Rheumatoid↗
PubMed1986

[Cervical spine in polyarthritis. Radiology, indications for surgery and results].

The rheumatoid changes in the spine that are of clinical importance are in the cervical part. They may cause dislocations in the cranio-vertebral region and - more uncommon - in lower levels. Most common is the horizontal dislocation between CI and CII, caused by destruction of the odontoid process and the area around it. This type can progress and give rise to the vertical dislocation caused by bone destruction in the joints between the occiput, CI and CII. The diagnosis is partly clinical and partially made by X-ray films. New radiological methods and new ways of using the old ones are discussed. Subaxial dislocations are not rare. Indications for surgery (fusion and possibly decompression) depend upon the progress of clinical symptoms and radiological findings, as do the surgical methods. The use of bone cement is increasing. Most authors advocate earlier surgical treatment. Subaxial fusion is difficult because of the poor condition of the bone.

Arthritis, Rheumatoid↗
PubMed1986

[Traumatic atlanto-occipital luxation. Value of new radiologic signs (apropos of 2 cases)].

Two cases atlanto-occipital dislocation with survival are reported. The displacement was anterior. One case was associated only with some pyramidal signs and was diagnosed fourteen months after the injury. The other was associated with immediate tetraplegia. Both cases were treated by occipitocervical fusion with plate fixation. The second case was reduced during operation. A review of the literature has shown that dislocation with anterior displacement is more severe than with posterior displacement. The diagnosis is always difficult. The authors show the importance of certain radiological signs such as the curved anterior line joining the odontoid process to the occiput. The need to reduce the displacement in old lesions is discussed.

Adolescent↗
PubMed1977

Brain-stem compression in rheumatoid arthritis.

A woman had cervical C-1 to C-2 subluxation with dysphagia. Initial improvement with halo cast and posterior fusion was followed by recurrence of symptoms, but transpharyngeal resection of the odontoid process had continued to alleviate symptoms at 18-month follow-up examination. The importance of vertical C-1 to C-2 subluxation in rheumatoid cervical arthritis is emphasized.

Arthritis, Rheumatoid↗
PubMed1982

[Heterogeneity of formes frustes of Morquio's disease].

Two children presenting with a mild form of Morquio's syndrome are reported. Clinically, there was a characteristic brevity of the trunk and slit lamp examination showed discrete corneal opacities. On X-ray films, generalized plastyspondylia was moderate but it was associated with hypoplasia of the odontoid process. Acetabula were enlarged with coxa valga; obliquity of inferior radio-cubital extremity was associated with a sharp pattern of the proximal end of metacarpi. Epiphyseal cartilage chondrocytes also looked like those of Morquio's syndrome: large cells containing numerous vacuoles, limited by a single smooth membrane. On the other hand, no keratosulfate was found in urines and N-acetylgalactosamine-6-sulfate-sulfatase and beta-galactosidase assays in fibroblasts were normal. Thus, this mild form is different from the so-called Morquio's syndromes types A and B.

Child↗
PubMed1983

[Atloaxoid dislocation with basilar pressure and spinal cord symptoms in rheumatoid arthritis. A case of occipitocervical arthrodesis followed by resection of the odontoid].

The authors report a case of atlanto-axial dislocation in a patient with rheumatoid arthritis. There was some neurological impairment with upper limb pain and hyperreflexia. As a first stage, a cranio-cervical fusion was performed through a posterior approach. Three weeks later the axis was excised through an antero-lateral approach, together with its odontoid process. The patient's condition was much improved and the neurological lesions disappeared.

Aged↗
PubMed1983

[Recent fractures of the odontoid. Prognostic factors].

A review of 92 recent fractures of the odontoid process suggests that they can be divided into two groups: stable fractures requiring no more than orthopedic treatment, and unstable fractures requiring surgery. Basing themselves on four main prognostic factors (direction and level of the fracture, distance between the fragments and age of the patients), the authors propose three types of surgical treatment differing in complexity and functional results: posterior C1-C2 arthrodesis, simple lacing with nylon threads and, quite recently, direct screwing by the antero-lateral approach.

Adolescent↗
PubMed1983

[A case of Morquio's syndrome with long survival time].

A long-surviving clinical case of suspected Morquio's syndrome is described. The locomotorium (vertebral dwarfism, hyphoscoliosis, but no hypoplasia of the odontoid process of the epistropheus, platyspondylia), cardiopulmonary (aortic insufficiency, arterial calcification, varices) visual (opaque lens on right eye, sclerosis of the lenticular lamellae but no corneal opacity on left eye) acoustic (deafness) and gastroenteric systems (hepatomegaly) are analysed. No pathological granulations were noted in the leukocytes. The plasmatic lysosome enzymes were normal and alpha-fucosidase subnormal. Abnormal keratan sulphate secretion was noted in the daily urine. All this would explain the patient's long survival.

Adult↗
PubMed1983

[Atloido-axoid surgery by a transoral approach].

The author has approached 18 atlanto-axial joints in 15 years by a transoral approach. Fourteen of the lesions were post traumatic, two congenital, one rheumatoid and one a tumour. It is concluded that the approach is a valuable one provided that there is adequate surgical technique, good antiseptic preparation, antibiotic therapy, provisional peroperative tracheostomy and special retractors. Use of adequate suture is also important. In some cases, magnification was needed. Medullary monitoring may also be helpful. The author estimates that the approach is more effective than extrabuccal techniques since it allows a direct exposure of the lesion. Large excisions are possible followed by reconstruction and grafting. It also allows screw fixation of the odontoid process. Two patients among earlier cases became infected but without serious long-term complications. Remaining cases have uncomplicated follow-up.

Adult↗
PubMed1984

[Atlanto-axial dislocations in children].

A series of 9 cases of atlanto-axial dislocation observed between 1976 and 1982 illustrates the wide range of etiologic factors as well as their possible implication. The findings were as follows: 3 congenital anomalies of the odontoid process, 2 luxations resulting from trauma, 1 spine infection, 2 Grisel syndromes, 1 psoriatic rheumatism. Among them 3 children had incomplete tetraplegia. Six patients were treated by posterior spine fusion either directly or after failure of conservative management. The authors emphasize the difficulty in relating the disorder to its real cause and discuss the various methods of treatment according to the etiology, whether reduction and stabilization are possible and according to the neural involvement and the date of onset of the disorders.

Adolescent↗
PubMed1984

Neuropathic arthropathy (Charcot joints) due to cervical osteolysis: a complication of progressive systemic sclerosis.

A patient with progressive systemic sclerosis who presented with a painless, destructive joint disease consistent with a neuropathic arthropathy is described. Roentgenogram of the cervical spine revealed marked osteolysis of C1 and C2 which allowed the odontoid process to migrate upward, compress and produce atrophy of the cervical spine cord. We suggest that these changes were responsible for the development of the neuropathic joints.

Adult↗
PubMedDate not supplied

Transoral atlantoaxial anterior decompression and fusion.

Two patients with atlantoaxial dislocation (one with an accompanying basilar impression) were treated by a combination of transoral anterior decompression and anterior fusion with good results. Transoral odontoidectomy is hazardous and difficult. However, modern high-speed drills increase the safety and diminish the difficulty of the procedure. If the displacement is irreducible and significant, removal of the protruding odontoid process is considered essential for relief of myelopathy. Simultaneous anterior fusion eliminates the necessity of a second operation, i.e., posterior fusion for stabilization of the atlantoaxial region.

Adult↗
PubMed1982

[Odontoid bone. Apropos of a case].

Reporting a clinical observation, the authors emphasize upon the extreme scarceness of this variety of so called "congenital" pseudarthrosis of the odontoid process. The congenital origin, due to a lack of fusion, or the acquired one by avascular necrosis following a trauma is explained. The diagnosis may be clinical, consisting either on a vertebral syndrome occurring in childhood, or on a neurological syndrome in the adult age. It is mainly radiological : A scanner investigation is presented here. Owing to the potential neurological severity of the disease, the posterior fusion has to be recommanded.

Cervical Vertebrae↗
PubMed1980

Transoral surgery for basilar impression.

A patient with basilar impression presented with a progressive myelopathy due to odontoid invagination. It was thought that a posterior decompression would be hazardous; therefore, the inferior clivus, odontoid process, and anterior arch of the atlas were removed transorally. We have found that, even with symptoms of long duration, marked improvement can be expected when the operation is targeted to the actual abnormality. In such cases, analysis of craniocervical tomograms will show the direction of medullary compression and thus indicate the correct surgical approach.

Axis, Cervical Vertebra↗
PubMed1980

Os Odontoideum.

A review of the cases of thirty-five patients with os odontoideum, the largest series reported to date, supports the concept that trauma is the etiology of the abnormality. Most of the patients had roentgenographic instability of the affected spinal segment, and were treated with spine fusion. Eleven patients had lesions attributable to injuries received before they were four years old, although surgical treatment usually was delayed for one to eight years. Nine patients had documented roentgenographic evidence of a normal odontoid process prior to the development of the os odontoideum. Only one-third of the patients had any signs or symptoms indicative of neural deficits, although most patients had cervical pain. Surgical treatment alleviated the pain and instability.

Adolescent↗
PubMed1994

[Surgical treatment of atlanto-axial dislocation in a patient of athetoid cerebral palsy].

The authors report a case of successful surgical treatment of atlanto-axial dislocation (AAD) secondary to athetoid cerebral palsy. A 61-year-old woman was admitted to our hospital in July 1993 complaining of progressive weakness in the right upper extremity and gait disturbance. She had been suffering from athetoid movements of her face, neck and arms due to cerebral palsy. Neurological examinations on admission revealed down-beat nystagmus on downward gazing, motor weakness of extremities, pallhypesthesia, hyperreflexia exaggerated in the right side and bilateral positive pathological reflexes. Lateral tomogram of the upper cervical spine demonstrated instability of the atlanto-axial joint, increased atlanto-dental interval (ADI) by 5.5 mm (in flexion), and narrowed canal at C1 level. Myelogram showed narrowed dural sac and angulation of the spinal cord at C1 level. A halo vest was applied two days before operation for reduction of the atlanto-axial junction and external fixation. She underwent posterior internal fixation using a Hartshill Ransford Loop combined with posterior decompression. This loop was secured to the occiput, C1, C2 and C3 by sublaminar wiring, and foramen magnum decompression and laminectomy of C1 were performed. Postoperative course was uneventful. Postoperative plain X-ray film, tomogram and computed tomography demonstrated good fixation (ADI was 2.5 mm) and excellent stability. There has been no problem during 6 months since the operation. It is known that involuntary movements in patients with athetoid cerebral palsy sometimes cause cervical spondylosis (especially at C3/4 and C4/5 level). Recently, AAD due to athetoid cerebral palsy has been reported. Almost every case of AAD secondary to athetoid cerebral palsy is combined with incompetence of the odontoid process.(ABSTRACT TRUNCATED AT 250 WORDS)

Athetosis↗
PubMed1994

Nystagmus and joint position sensation: their importance in posterior occipitocervical fusion in rheumatoid arthritis.

It is widely believed that brain stem dysfunction and cranial nerve palsies in patients with rheumatoid arthritis (RA) are common and related to the vertical translocation of the odontoid process. In our database of 235 patients with seropositive RA and craniocervical junction involvement, we have found a very low incidence of such problems. Long tract signs were common, but loss of proprioception (joint position sensation) as the sole neurologic deficit was rare. Nystagmus was found to be associated with the tonsillar herniation of a Chiari 1 malformation and loss of joint position sensation with severe compression of the posterior aspect of the spinal cord at the craniocervical junction. The implications for posterior occipitocervical fusion, particularly by sublaminar wiring, are discussed.

Adolescent↗