Atlantoaxial subluxation is often associated with both causes of compression and may be further exacerbated by the development of cranial settling. Radiographic evidence of neural element compression is best demonstrated by magnetic resonance imaging because of its excellent soft tissue contrast. The establishment of normal spinal alignment by cervical traction may, by itself, achieve adequate decompression. However, in some cases, such as those involving an irreducible lesion, a transoral approach may be needed. The likelihood of neurologic improvement and pain relief after surgical intervention in rheumatoid arthritis patients is generally good and is closely related to the patient's preoperative neurologic status.
Results are best in patients with the fewest preoperative neurologic deficits.
Therefore, early surgical intervention in symptomatic patients with radiographic evidence of neural element compromise seems to offer the best outcome. Summary Rheumatoid arthritis is associated with several pathologic changes in the cervical spine, including loss of articular cartilage, ligamentous destruction, and bone erosion. These changes may lead to one or a combination of complications, including atlantoaxial subluxation, cranial settling, subaxial cervical subluxation, and periodontoid pannus formation. Surgical management of these problems should focus on relieving pain, stabilizing the spine, and decompressing neural elements. References Heywood AW, Learmonth ID, Thomas M. Cervical spine instability in rheumatoid arthritis.