Arthritis of the neck involves about 10% of rheumatoid patients, the atlantoaxial level and the facet joints being the most common structures involved. Atlantoaxial subluxation and pannus formation around the odontoid made medulla and cervical spinal cord at risk of compression and are lifethreating in 5% to 10% of rheumatoid patients. Nevertheless clinical assessment of myelopathy and serial RX studies are not always valid prediction criteria of neurologic disease progression. In the order to identify the frequence of large periodontoid pannus in patients with minor or no neurological impairment, we have been studying such patients with MR of the neck in addition to normal RX and CT scan. In the present paper we report about 3 patients which complained of only mild to moderate neck pain, without major neurological signs of cervical myelopathy. RX performed in flexion and extension showed abnormal antero-posterior movement at the C1-C2 level in all cases, associated to vertical traslocation of the odontoid in one case. MR well documented a great amount of pathological soft periodontoid tissue, hypo-isointense both in T1 and T2-weighted sequences, without compression on the cervical spine. Two patients were studied also after intravenous gadolinium and showed clear enhancement of the soft tissue mass. Surgical posterior fixation without clinical or radiological evidence of neuraxial compression is commonly indicated only in the presence of documented atlantoaxial subluxation progression. Nevertheless we think that even slight abnormal movements at C1-C2 level may sustain periodontoid pannus proliferation accelerating the development of myelopathy also in patients without radiological evidence of atlantoaxial subluxation progression. According to preliminary observations of the pannus reduction after surgical cervical stabilization, we propose an extensive MR cranio-cervical junction monitoring in rheumatoid patients with minor neurological impairment; posterior surgical fixation should be advised in presence of large periodontoid pannus with a double goal: 1) prevention of neuraxial compression; 2) stabilization or reduction of periodontoid pannus.
|Translated title of the contribution||MR of rheumatoid atlantoaxial pannus in patients with minor neurological impairment|
|Number of pages||8|
|Journal||Rivista di Neurobiologia|
|Publication status||Published - 1993|
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