The Role of Preoperative Cervical Spine X-rays in Rheumatoid Arthritis

Abstract

The cervical spine is frequently involved in rheumatoid arthritis and yet there exists no consensus on the need to screen for cervical spine subluxations preoperatively. We reviewed retrospectively 77 patients who underwent 132 operations under general or regional anaesthesia over a 44-month period. We found that while the majority of patients had received preoperative X-ray screening for cervical spine instability, a third of the X-ray examinations done had been inadequate. Many anaesthetists did not repeat cervical spine X-rays if there were previously performed views available. We showed that a complete X-ray examination of the cervical spine should include flexion and extension stress views in addition to frontal views of the odontoid and entire cervical spine. Anterior atlantoaxial subluxation was the most common subluxation encountered in our study population. The detection of cervical spine instability was found to significantly affect anaesthetic management, favouring techniques that avoided unprotected manipulations of the neck under anaesthesia.

Long-term follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis

“…There are, however, no guidelines regarding whether radiographs of the cervical spine should be obtained on a regular basis and previous studies have found contrasting results about whether cervical spine radiographs are indicated prior to anaesthesia (4,(46)(47)(48). We observed that cervical spine damage could already be present in the early disease years.…”

Evaluation of the Cervical Spine Among Patients With Rheumatoid Arthritis

“…Studies on the involvement of the cervical spine in patients with rheumatoid arthritis have not been prominent within the Brazilian setting. Systematic periodic evaluation of the cervical spine among patients with rheumatoid arthritis should be performed routinely in rheumatology and orthopedics services, but it is not even done preoperatively for a significant proportion of the patients (13) .…”

“…We observed in our study that 60% (9/15) of the patients with atlantoaxial subluxation presented a normal anterior atlantodental distance (less than 3 mm) on the lateral radiograph in neutral position ( Figure 4 ). Kwek et al (13) demonstrated that the difference in the detection rate for instabilities of the cervical spine between radiographic views in a stressed position (dynamic) and non-stressed position (neutral) was statistically significant (p < 0.05). Basilar invagination may be difficult to diagnose on simple radiographs, to such an extent that several techniques for diagnosing it exist.…”

Perioperative Management of Patients with Rheumatic Diseases

“…Furthermore, lateral flexion/extension cervical spine films must be considered to evaluate C1-2 stability if a patient is undergoing orthopedic surgery in patients with RA, ankylosing spondylitis (AS), and in any patient with neck pain or crepitus on ROM testing, radicular pain or limb weakness. Consider MRI if plain films are abnormal, and in patients with neurologic symptoms and signs of spinal cord compression [8-11]. …”