Lege Artis Medicinae

[The cervical spine in rheumatoid arthritis]

KORDA Judit1, VERES Róbert2

MAY 01, 2000

Lege Artis Medicinae - 2000;10(05)

[The neck is the third most common site of involvement after the hands and feet in rheumatoid arthritis (RA). Deformities of the cervical spine can appear in the early stage of the disease, but most often they are seen in patients with rheumatoid arthritis with more than ten years of duration. Progression of the deformity is unpredictable, but follow up for five to ten years has shown the worsening of the instability in 16-80% of the patients. Many patients with rheumatoid disease of the cervical spine remain asymptomatic for years, but they are at risk of a range of neurological complications and even sudden death from me dullary compression. Neurological abnormalities may be subtle and difficult to establish in the presence of deforming arthritis. Once myelopathy develops, it is usually rapidly progressive. The primary goal in the management of the cervical spine is to prevent the onset of irreversible neurological deficit. Patients should have regular physical examinations to avoid the masking of subtle changes of myelopathy by severe peripheral joint disease. Use of the different measurements, especially posterior atlantodental interval and subaxial canal diameter measured on plain lateral cervical radiograph is a reliable screening tool to identify high risk patients who require further evaluation. The primary technical objective of surgery is stabilization of the diseased spinal segments and relief of spinal cord compression via reduction of subluxation or decompression. Complications are not uncommon, but tend to occur less frequently, and neurological recovery is most favorable when severe cord compression is not present preoperatively. ]

AFFILIATIONS

  1. Országos Reumatológiai és Fizioterápiás Intézet, Budapest
  2. Országos Idegsebészeti Tudományos Intézet

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