Spontaneous Dislocation of the Atlanto‐Axial Joint in Rheumatoid Spondylitis

Margulies, Milton; Katz, lsadore; Rosenberg, Meyer

doi:10.1212/wnl.5.4.290

Cited by 25 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three of these patients underwent traction prior to surgery. [3][4][5][6][7]11,13,14,[18][19][20][21][22]28,31,33,34,36,37 One of the patients in this series had an odontoid fracture as his primary pathology at the CVJ. Multiple case reports have documented the occurrence of odontoid fractures in patients with ankylosing spondylitis.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5]7,8,10,11,13,14,[19][20][21][22]28,31,33,34,36,37 In addition, erosion of the C1-2 facet joints, 4,10,14,18 erosion of the lateral mass of C-1, 6,10,19 erosion of the anterior arch of C-1 and/or odontoid process of C-2, 10,21,22 hypertrophy of the odontoid process, 21 and varying degrees of spontaneous fusion of the occiput, C-1, and C-2 19,21,22,28,33 have been reported. Our patients demonstrated a similar spectrum of radiographic findings.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have suggested that the transverse ligament and other ligaments of the CVJ and cervical spine may be affected by ankylosing spondylitis, possibly due to inflammation and hyperemia, therefore impairing atlantoaxial stability. 10,14,20,28,29,34,37 Others have suggested that bone erosion plays a significant role in the development of subluxations at the CVJ. 10,21,22,34,37 Specimens from the ventral decompression in 3 patients were submitted for pathological analysis.…”

Section: Discussionmentioning

confidence: 99%

“…One of the previous case reports did identify fibrocartilaginous tissue with inflammatory cells in the bone from dorsal decompression. 20 A recent case-control series comparing the facet joints of patients with ankylosing spondylitis to tissue from normal controls obtained at autopsy demonstrated inflammatory infiltrates in the affected joints. 1 Little et al 19 reported on the autopsy findings of a patient with CVJ pathology due to ankylosing spondylitis.…”

Section: Discussionmentioning

confidence: 99%

“…16,17,21,29,35,38 Most reports detailing the presentation and treatment of CVJ disease and ankylosing spondylitis are limited to case reports and small case series. [3][4][5][6]11,13,14,[18][19][20][21][22]28,31,33,34,36,37 In 1961, Sharp and Purser 32 reported on 22 patients with ankylosing spondylitis and atlantoaxial subluxation. Among these patients, the most common presenting signs and symptoms were pain, occipitocervical deformity, and neurological deficits.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Albert¹,

Menezes²

2011

SPI

View full text Add to dashboard Cite

Object The objective of this study was to describe a single surgeon's experience managing craniovertebral junction (CVJ) disease due to ankylosing spondylitis. Methods The authors undertook a retrospective review of the records of patients with CVJ disease due to ankylosing spondylitis who were evaluated and treated by the senior author. Charts were reviewed for symptoms and signs at presentation, radiography results, treatment, and outcome. In addition, some of the patients had pathology reports available for review. Results Eight patients with CVJ disease due to ankylosing spondylitis were identified who were evaluated by the senior author in the years 1990–2008. The most common presenting symptoms were neck pain (37.5%), cranial neuropathy (37.5%), and sensory disturbance (62.5%). On examination, the most common findings were limited cervical range of motion (37.5%), weakness (50%), and myelopathy (75%). Radiographic evaluation revealed atlantoaxial subluxation, retroodontoid pannus formation, basilar invagination, and bone erosion. Surgery was offered to all of the patients, 7 of whom underwent operations. In most cases, the treatment was transoral–transpalatopharyngeal decompression followed by occipitocervical fusion. One patient with a reducible lesion underwent dorsal fusion alone. Neurological outcomes were favorable overall. Conclusions The incidence of CVJ disease in patients with ankylosing spondylitis varies among reports. These cases are rare in most neurosurgery clinics. It is important to recognize that patients with ankylosing spondylitis are at risk for CVJ disease, similar to patients with rheumatoid arthritis. Principles common to the management of other CVJ pathologies apply to these patients as well.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Albert¹,

Menezes²

2011

SPI

View full text Add to dashboard Cite

show abstract

Atlantoaxial Subluxation in Psoriatic Arthropathy

Giuliano¹,

Scully²

1972

Arch Dermatol

View full text Add to dashboard Cite

Spinal cord involvement by C4–C5 Vertebral subluxation in rheumatoid arthritis: A description of 2 cases examined at necropsy

Hughes

1977

Annals of Neurology

View full text Add to dashboard Cite

In 2 cases of severe, longstanding rheumatoid arthritis involving the cervical spine, a progressive spinal cord syndrome developed in which spastic paraparesis was combined with a lower motoneuron paresis affecting the upper limbs. In both cases necropsy showed the cause to be subluxation between the C4 and C5 vertebral bodies and backward encroachment into the spinal canal of the upper and posterior part of the C5 vertebral body. A feature of the spinal cord abnormality was central infarction, apparently caused by an effect on a patent anterior spinal artery and manifested not only at the site of spinal cord compression but for several spinal cord segments caudal to this level. [7, 8,[13][14][15][16][17]. Subaxial dislocations are less common, and in neither has the pathological abnormality of the spinal cord been studied in detail. For these reasons the present report records the findings in 2 cases of subaxial dislocation in which the mechanism of spinal cord damage was studied at necropsy. Patient 1For the seven years preceding her death in 1974 at the age of 57 years, this woman had suffered from severe, mutilating, seropositive rheumatoid arthritis; during this time she had been vigorously treated with steroids and azathioprine. In the three years before her death she had suffered neck pains, and roentgenograms showed marked abnormalities of the cervical spine (Fig 1). She had then experienced the gradual onset and progression of a spastic paraparesis, affecting her right side more than her left, accompanied by a complicated pattern of sensory loss. One year before her death she developed lower motoneuron weakness in both arms, right more than left. Wasting and weakness were detectable in most of the upper limb muscles, right more than left.However, the severe deformity and immobility caused by the arthritis made it very difficult to determine on clinical grounds how much of this wasting and weakness was due to denervation. By electromyography, evidence of denervation (denervation potentials, including fibrillation or positive potentials or both) was found on the left side in the deltoid, biceps brachii, and extensor digitorum muscles and on the right side in the deltoid, extensor digitorum, and first dorsal interosseus muscles. She died from bronchopneumonia after a week of respiratory weakness. Genevul Necropsy FindingsExtensive bilateral bronchopneumonia was present. The other internal organs were unremarkable. The brain was normal.FIXED SPINE. The cervical and upper thoracic spine had been fixed with the spinal cord in situ. The vertebral arteries had been injected with radiopaque material and were demonstrated to be patent. Externally the specimen was abnormal in having a pronounced curve, convexity backward, in the upper cervical region, while anteriorly there was prominent midline swelling some 1.5 cm in diameter due, as was confirmed by postmortem roentgenograms, to forward protrusion of the lower part of the C4 vertebral body.From the Department of Neuropathology, Radcliffe Infirmary, Address repr...

show abstract

Spontaneous Dislocation of the Atlanto‐Axial Joint in Rheumatoid Spondylitis

Cited by 25 publications

References 0 publications

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Ankylosing spondylitis of the craniovertebral junction: a single surgeon's experience

Atlantoaxial Subluxation in Psoriatic Arthropathy

Spinal cord involvement by C4–C5 Vertebral subluxation in rheumatoid arthritis: A description of 2 cases examined at necropsy

Contact Info

Product

Resources

About