Cervical spine instability in rheumatoid arthritis

  • Filipa Camacho da CôrteEmail author
  • Nuno Neves
General Review


Rheumatoid arthritis (RA) is the most common inflammatory disease of the cervical spine (CS). After hands and feet, CS is the most commonly involved segment, being present in more than half of the patients with RA. Especially in the CS, RA may cause degeneration of ligaments, leading to laxity, instability and subluxation of the vertebral bodies. This is often asymptomatic or symptoms are erroneously attributed to peripheral manifestations. Otherwise, this may cause compression of spinal cord (SC) and medulla oblongata leading to severe neurologic deficits and even sudden death. Owing to its potentially debilitating and life-threatening sequelae, inevitable progression once neurologic deficits occur and the poor medical condition of afflicted patients, CS involvement remains a priority in the diagnosis and its treatment will remain a challenge. The surgical approach aims a solid fixation of the upper cervical spine, giving stability, preventing neurologic deterioration and injury to the SC, leading to improved neurologic function, vascular integrity and maintenance of sagittal balance. The recent advances in surgical techniques, complete understanding of the anatomy and precise preoperative evaluation led to safer and more effective procedures that have decreased complication rates. Based on the fact that when a patient becomes myelopathic the rate of long-term mortality increases and the chance of neurologic recovery decreases, many authors agree that early surgical intervention, before the onset of neurologic deficits, gives a more satisfactory outcome. However, the timing when a prophylactic stabilization should occur is poorly defined, and so, patients with radiographic instability but without evidence of neurologic deficit are still the most difficult to manage.


Rheumatoid arthritis Cervical spine Surgery 



Anterior atlantoaxial subluxation


Anterior atlanto-dens interval


Atlantoaxial subluxation


Cervicomedullary angle


Cranial settling


Cervical spine


Computer tomography


Craniovertebral junction




Magnetic resonance imaging


Posterior atlas-dens interval


Rheumatoid arthritis


Rheumatoid factor


Space available for the spinal cord


Subaxial subluxation


Spinal cord


Subaxial spinal canal diameter


Upper cervical spine


Vertebral arteries


Conflict of interest



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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Faculty of MedicineCentro Hospitalar de São JoãoViana do CasteloPortugal
  2. 2.Spine Group, Orthopedic Department, Faculty of Medicine, Centro Hospitalar de São João. INEB, Instituto de Engenharia BiomédicaUniversity of PortoPortoPortugal

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