![]() Krauss WE, Bledsoe JM, Clarke MJ, Nottmeier EW, Pichelmann MA (2010) Rheumatoid arthritis of the craniovertebral junction. Mańczak M, Gasik R (2017) Cervical spine instability in the course of rheumatoid arthritis–imaging methods. Heinlen L, Humphrey M (2017) Skeletal complications of rheumatoid arthritis. In Surgery of the Cranio-Vertebral Junction. Nat Rev Rheumatol 11:276–289ĭas KK, Pandey S, Gupta S, Behari S (2020) Rheumatoid Cervical Myelopathy. Smolen JS, Aletaha D (2015) Rheumatoid arthritis therapy reappraisal: strategies, opportunities and challenges. McInnes IB, Schett G (2017) Pathogenetic insights from the treatment of rheumatoid arthritis. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients. Patients with atlantoaxial instability have better functional and neurologic outcomes. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Early diagnosis and treatment of cervical spine involvement is critical. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. As many as 86% of patients suffering from RA have cervical spine involvement. Uncovertebral arthrosis typically appears as pitting of the articular surface and an overall distortion of the uncinate process with associated osteophyte formation.Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. It typically is seen in the lower cervical vertebrae due to the increased load at these levels. Uncovertebral arthrosis is thought to be the result of dehydration/reduction of the intervertebral disc, leading to an increased load between the cervical vertebrae and hence the uncovertebral joints. Posterior spurring can impinge on the intervertebral foramen 1, whilst anterior osteophytes combined with fibroligamentous thickening can compress the anterior-medial aspect of the vertebral artery 1. Clinical presentation will vary it could be a sudden onset of pain, stiffness or even chronic pain however, it can also be asymptomatic. There generally is distinguished osteophytes which can affect close anatomical structures.
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