Predictors of paralysis in the rheumatoid cervical spine in patients undergoing total joint arthroplasty

The Journal of Bone and Joint Surgery. American Volume
Jonathan N GrauerAlan S Hilibrand

Abstract

Rheumatoid arthritis is sometimes associated with radiographic evidence of instability of the cervical spine, most commonly an abnormal subluxation between vertebrae. When this instability compromises the space that is available for the spinal cord, it may be predictive of paralysis. However, the prevalence of radiographic signs of instability that are predictive of paralysis among patients with nonspinal orthopaedic manifestations of rheumatoid arthritis is unknown. Radiographs of the cervical spine of patients with rheumatoid arthritis who had undergone total joint arthroplasty over a five-year period were retrospectively reviewed. The radiographs were evaluated for predictors of paralysis (a posterior atlantodental interval of <14 mm or a subaxial space available for the cord measuring <14 mm) and were compared with traditional parameters of instability (an anterior atlantodental interval of >3 mm or subaxial subluxation of >3 mm). Forty-nine of the sixty-five patients who were identified had flexion and extension lateral radiographs available for review. Only one of these patients had a posterior atlantodental interval of <14 mm, and only three had a space available for the cord that measured <14 mm at one level or more. In...Continue Reading

References

May 1, 1989·Arthritis and Rheumatism·J T HallaG S Alarcón
Apr 1, 1981·Annals of the Rheumatic Diseases·J WinfieldM Corbett
Sep 1, 1993·The Journal of Bone and Joint Surgery. American Volume·S D BodenG R Rechtine
Mar 12, 1998·Rheumatic Diseases Clinics of North America·B A RawlinsO Boachie-Adjei
Jan 11, 2000·Clinical Orthopaedics and Related Research·S J Dreyer, S D Boden
Nov 28, 2000·Scandinavian Journal of Rheumatology·D ChristenssonU Rydholm

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