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The course of atlanto-axial involvement and disc narrowing of the cervical spine in rheumatoid arthritis.

In 188 patients with rheumatoid arthritis 585 radiological examinations of the cervical spine were performed. Subluxation of C1-2 was found more often than expected; it was often the only radiological change in that segment, and its degree was not related to the duration of the disease. Lateral radiographs taken in full flexion were important for the diagnosis. Age over 40 years at the onset of RA, increased ESR at least on one occasion and seropositivity were related to more severe degrees of involvement. The presence of subcutaneous nodules, high titres of the Rose-Waaler reaction and the presence of antinuclear antibodies had no definite relation to the degree of involvement.

Adolescent↗

Craniovertebral anomalies.

We have tried to clarify this confusing area by demonstrating the common relationships of these abnormalities. The development of the craniovertebral junction was present in order to understand the formation of the anomalies discussed. The radiologic lines and measurements that have been described are actually to measure the degree of compromise of the functional size of the foramen magnum. This mechanical compromise, either from direct neural compression and/or from a secondary vascular impairment (arterial or venous), leads to the signs and symptoms of cervicomedullary compression.

Adult↗

Vertical atlanto-axial subluxation in rheumatoid arthritis.

In a prospective survey of 476 hospital in-patients with rheumatoid arthritis, vertical atlanto-axial subluxation (AAL) was found in 13 patients (3.7 per cent). All were women with severe rheumatoid arthritis. Neurological signs were found in ten patients, and in seven they appeared to be due to vertical AAL. The signs caused by vertical AAL were diminished pain and temperature sensation in the upper divisions of the trigeminal nerve, sensory loss in the areas supplied by C2, nystagmus and pyramidal lesions. Disabling involvement due to vertical AAL was not found although it may occur and the lesion may be fatal. The lower cervical spine was involved in all patients and severe lesions were seen in nine. The most severe neurological lesions appeared to be due to subaxial subluxation. Corticosteroid therapy may have been a contributing factor in four patients.

Adult↗

Long-term corticosteroids and cervical subluxation in non-rheumatoid patients.

Forty-five non-rheumatoid patients with chronic chest disease were examined radiographically for evidence of cervical subluxation. Twenty-six patients had received continuous corticosteroids for periods of between two and 20 years. The remainder (19 patients) had never been treated with steroids and acted as controls. There was no difference in atlanto-axial distance between the steroid-treated and control groups and in no patient did this measurement exceed 3 mm. However, subaxial subluxation was significantly increased in the steroid-treated group, directly related to the duration of steroid therapy (P less than 0.025).

Adrenal Cortex Hormones↗

Computed tomography of spinal fractures.

Computed tomography (CT) has aided significantly in the diagnosis and management of spinal fractures. The examination is easy, relatively quick, and avoids potentially harmful manipulation. The diagnostic advantages of CT include precise anatomic delineation and indication of extent of fractures, assessment of spinal stenosis, and demonstration of associated peraspinal lesions.

Adult↗

Traumatic atlantoaxial dislocation causing os odontoideum in infants.

The pathogenesis of os odontoideum is still a subject of debate. The authors encountered two infants who had traumatic atlantoaxial dislocation and in whom os odontoideum later developed. One of the infants died of tardive cervical myelopathy secondary to cord compression. The authors present their concept that postnatal development of this abnormality results from fracture of the odontoid.

Axis, Cervical Vertebra↗

Sequelae of atlantoaxial stabilization in two patients with Down's syndrome.

Two patients with Down's syndrome and associated atlantoaxial instability with a chronically narrow spinal canal at C1-2 underwent surgical procedures in which the lesion was manipulated and posterior wiring and fusion were done. Both patients developed quadriplegia from the surgery. The authors recommend preoperative traction to reduce the deformity, then surgery with the traction maintained as a method to avoid this complication. Further, if reduction does not occur with traction, onlay grafting is recommended, avoiding any sublaminar wiring.

Adult↗