Rheumatoid arthritis of the cervical spine

ABSTRACT

Rheumatoid arthritis is often a progressive, destructive systemic disease that may involve the cervical spine resulting in a variety of instability patterns. These patterns include atlantoaxial instability, subaxial subluxation and basilar invagination alone or in combination. Routine imaging studies such as lateral flexion, and extension plain radiographs and a magnetic resonance imaging allow an objective assessment of the degree of cervical spinal involvement in terms of neurologic compromise and spinal instability. At this time, the posterior atlantodental interval [PADI] and the subaxial spinl canal diameter [SCD] measured on a lateral plain radiograph, and/or the space available for the cord [SAC] measured on a sagittal magnetic resonance image are the best prognostic indicators for future neurologic embarrassment, while the Ranawat classification is the best prognostic indicator for postoperative neurologic recovery. A thorough understanding of the natural history of rheumatoid arthritis and the prognostic relevance of contemporary imaging modalities will allow one to manage this unforunate disease process and minimise the functional impairment and complications seen in patients with rheumatoid arthritis of the cervical spine