Vertical Subluxation of the Axis in Rheumatoid Arthritis

Hangman's fracture in ankylosing spondylitis preceded by vertical subluxation of the axis

“…Vertical subluxation of the axis, as described in rheumatoid arthritis (12,13), has been associated with vascular obstruction, signs and symptoms of brain stem compression, and sudden death. Our patient did experience episodes of sudden collapse and in fact, the fall leading to the fracture was related to one such episode.…”

Superior, posterior, and lateral displacement of c1 in rheumatoid arthritis

“…The onset of cervical spine disease in rheumatoid arthritis has not been shown to have prognostic significance (13). Vertical subluxations, however, have been associated with a worse prognosis (6)(7)(8)11,19,20). In addition, there is poor clinical correlation between the degree of subluxation and the neurologic deficits, as is also the case in patients with traumatic fracture-dislocations of the cervical spine (20).…”

“…Our patient had no osseous destruction, and the anterior, lateral, superior, and posterior motion of C1 on C2 may be explained only by laxity or dissolution of the transvers-e and alar ligaments. In the second, severe cartilage and bone destruction may be observed without evidence of ligamentous involvement, resulting in the backward subluxation of the atlas (8,21). Previously, it had been thought that in order for this to occur, there must be destruction or congenital absence of the anterior arch of the atlas or the odontoid process (1)(2)(3)(4)(5).…”

Rheumatoid Cervical Myelopathy

“…Studies of the clinical course of this condition, however, suggest that patients with rheumatoid arthritis of the cervical spine do not have any shorter life expectancy than other patients with rheumatoid arthritis.3 Perhaps the infrequent severe vertical subluxation is a circumstance of special risk, though even then the outlook is not always bad. 10 Other than that rare event of sudden death, a wide range of symptoms and signs (neck pain or clicks, sensory symptoms, weakness of limbs) has been listed,7 11 but a recentdescription of the clinical findings in 31 patients with rheumatoid cervical myelopathy makes thoughtful reading.12 Most patients had a sensory deficit, and about one-third had motor problems or disturbances of bladder function. The abnormal signs were usually sensory, though half the patients had a spastic tetraparesis.…”