Cervical spine instability in the course of rheumatoid arthritis – imaging methods

Reumatologia, 2017 · DOI: https://doi.org/10.5114/reum.2017.69782 · Published: April 1, 2017

Rheumatology Medical Imaging Orthopedics

Simple Explanation

Rheumatoid arthritis (RA) commonly affects the cervical spine, leading to instability in the joints and ligaments. This instability can manifest as atlanto-axial subluxation, subaxial subluxation, or cranial settling. In severe cases, it can result in spinal stenosis and spinal cord injuries with neurological symptoms. Identifying cervical spine instability in RA patients before neurological complications arise poses a diagnostic challenge. This article reviews imaging methods, including plain radiographs, magnetic resonance imaging (MRI), and computed tomography (CT), to diagnose cervical spine instability in RA. Each imaging method offers unique advantages and disadvantages for assessing the cervical spine. Understanding these aspects is crucial for determining the appropriate timing of surgical intervention for patients with RA-related cervical spine instability.

Study Duration

Not specified

Participants

Patients with rheumatoid arthritis

Evidence Level

Review paper

Key Findings

1
Plain radiographs are a common initial imaging method due to their availability and low cost, particularly for assessing atlanto-axial joint anomalies using functional radiographs in flexion and extension.
2
Computed tomography (CT) provides a precise assessment of bone structures in the cervical spine and is particularly useful for identifying basilar invagination and bone erosion, as well as for surgical planning.
3
Magnetic resonance imaging (MRI) is the preferred method for assessing cervical spine involvement in RA, offering detailed visualization of bone structures, soft tissues, and inflammatory lesions, as well as detecting spinal cord compression.

Research Summary

Cervical spine involvement is common in rheumatoid arthritis (RA) and can lead to various types of instability, potentially causing neurological complications. Early identification of these instabilities is crucial. Imaging methods such as plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) play a vital role in diagnosing and assessing cervical spine instability in RA. Each method has unique advantages and disadvantages. MRI is the method of choice for assessing soft tissues and spinal cord compression, while CT is useful for bone assessment and surgical planning. Plain radiographs remain a valuable initial screening tool.

Practical Implications

Diagnostic Algorithm

The use of plain radiographs as an initial screening tool, followed by MRI for confirmation and detailed assessment, can optimize the diagnostic process for cervical spine instability in RA.

Surgical Planning

CT imaging is crucial for surgical planning, enabling the selection of appropriate techniques and implant sizes.

Monitoring and Management

Regular monitoring of cervical spine stability using lateral radiographs in flexion and neutral positions is recommended for patients with suspected cervical involvement in RA.

Study Limitations

1
The diagnostic value of single criteria for basilar invagination is limited; a combination of criteria is recommended.
2
Plain radiographs have limited ability to assess soft tissues and spinal cord compression.
3
MRI may have contraindications for patients with ferromagnetic implants or other medical devices.

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