Cervical spine instability in the course of rheumatoid arthritis - imaging methods

Abstract

Cervical spine is affected in more than a half of patients with rheumatoid arthritis (RA). Depending on the degree of damage to the individual joints and ligaments RA-related cervical spine instability takes the form of atlanto-axial subluxation, subaxial subluxation or cranial settling. In the advanced cases spinal stenosis can occur as well as spinal cord injuries with typical neurological symptoms. The identification of patients with cervical spine instability before the occurrence of neurological complications still constitutes a diagnostic challenge. The article presents the methods of cervical spine imaging with the use of plain radiographs, magnetic resonance imaging (MRI) and computed tomography (CT). We discuss the advantages and disadvantages associated with each method and the possibility of its application in the diagnosis of cervical spine instability in RA. The knowledge of the above mentioned issues is indispensable to select an appropriate time for surgical intervention.

Keywords: cervical spine; imaging; rheumatoid arthritis.

Fig. 1

Lateral neutral (A), flexion (B) and extension (C) radiographs.

Fig. 2

Diagnostic criteria of cranial settling: chamberlain and McGregor lines (A); Ranawat criterion (B); Redlund-Johnell criterion (C); Clark station criterion (D).

Fig. 3

Sagittal T1-weighted MR image.

Fig. 4

Sagittal (left) and axial (right) T2-weighted MR images.