J Korean Neurosurg Soc.  2019 Nov;62(6):661-670. 10.3340/jkns.2018.0234.

Upper Cervical Subluxation and Cervicomedullary Junction Compression in Patients with Rheumatoid Arthritis

• Chung J
• Bak KH
• Yi HJ
• Chun HJ
• Ryu JI
• Han MH

• KMID: 2463658
• DOI: http://doi.org/10.3340/jkns.2018.0234

Abstract

OBJECTIVE
Rheumatoid arthritis (RA) is known to involve the cervical spine up to 86%. It often causes cervical instability like atlantoaxial subluxation (AAS), subaxial subluxation, and vertical subluxation (VS). In order to find the relation between RA and cord compression, we will evaluate the characteristics and risk factors of basilar invagination (BI) and cervicomedullary junction (CMJ) compression.
METHODS
From January 2007 to May 2015, 12667 patients administrated to Hanyang University Medical Center. Four thousand three hundred eighty-six patients took cervical X-ray and 250 patients took cervical computed tomography or magnetic resonance imaging. Radiologic parameters, medication records were obtained from 242 patients. Multivariate logistic regression analysis was performed with correlation of CMJ compression, basin-dental interval (BDI), basin-posterior axial line interval (BAI), pannus formation, BI, and AAS.
RESULTS
In the point of CMJ compression, atlantodental interval (ADI), posterior-atlantodental interval, BAI, AAS, and BI are relatively highly correlated. Patients with BI have 82 times strong possibility of radiologic confirmed CMJ compression, while AAS has 6-fold and pannus formation has the 3-fold possibility. Compared to the low incidence of BI, AAS and pannus formation have more proportion in CMJ compression. Furthermore, wrist joint erosion was correlated with VS and AAS.
CONCLUSION
BI has a very strong possibility of CMJ compression, while AAS and pannus formation have a high proportion in CMJ compression. Hence bilateral wrist joint erosion can be used as an indicator for the timing of screening test for cervical involvement. We suggest the early recommendation of cervical spine examination for the diagnosis of cervical involvement in order to prevent morbidity and mortality.

Keyword

Rheumatoid arthritis; Brainstem compression

MeSH Terms

Academic Medical Centers
Arthritis, Rheumatoid*
Diagnosis
Humans
Incidence
Logistic Models
Magnetic Resonance Imaging
Mass Screening
Mortality
Risk Factors
Spine
Wrist Joint

Figure

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  Fig. 1. Flow chart of the process for selecting eligible patients for present study. RA : rheumatoid arthritis, OPD : out patient department, HYMC : Hanyang University Medical Center, WNL : with in normal limit, Ant. : anterior, ADS : atlantodental subluxation, VS : vertical subluxation, MRI : magnetic resonance imaging, CT : computed tomography, AAS : atlantoaxial subluxation, pVD : pathologic vertical dislocation, BI : basilar invagination, SAS : subaxial subluxation.

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  Fig. 2. ROC curve analysis was performed in radiologic morphologic parameters. Note that area under the curve of BAI is larger than that of ADI and McR, which indicates higher sensitivity and specificity. BAI : basin-posterior axial line interval, ADI : atlantodental interval, McR : McRae’s line and the tip of odontoid process of the axis, BDI : basindental interval, pADI : posterior-atlantodental interval, ROC : receiver operating characteristics.

Reference

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