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. 2020 Sep-Oct;11(5):876-882.
doi: 10.1016/j.jcot.2019.06.013. Epub 2019 Jun 14.

Prevalence of cervical spine instability among Rheumatoid Arthritis patients in South Iraq

Husham A Al-Daoseri  1 , Mubder A Mohammed Saeed  2 , Rafal A Ahmed  3
Affiliations

Prevalence of cervical spine instability among Rheumatoid Arthritis patients in South Iraq

Husham A Al-Daoseri et al. J Clin Orthop Trauma. 2020 Sep-Oct.

Abstract

Aim of the work: This study analysed the prevalence of cervical spine instability in Rheumatoid Arthritis (RA) patients following at a single centre in Basrah.

Patients and methods: Data were collected directly from patients through cervical spine examinations. Each patient was sent for dynamic (flexion and extension) lateral cervical radiographic imaging to assess the presence of atlantoaxial subluxation (AAS), superior migration of the odontoid (SMO) and sub-axial subluxation (SAS). Patients with positive radiographic findings were sent for MRI scans of the cervical spine to assess neurological compression.

Results: The prevalence rate of cervical spine instability in RA was 15/203 (7.4%) of the total sample, occurring primarily in patients of 37-65 years old (mean: 48 ± 8.9 years), were 3/15 (20%) aymptomatic. The majority (60%) being at the moderate stage of the disease activity (using a Clinical Disease Activity Index [CDAI). In terms of type of cervical spine involvement, isolated AAS was found to have the highest occurrence (73.3%), followed by combined SAS and SMO (13.3%), combined AAS and SMO (6.7%), and combined AAS and SAS (6.7%). A significant relationship was found between the type of cervical spine involvement in RA and a disease onset duration, disease activity, body mass index and peripheral erosion with P value < 0.05.

Conclusion: Cervical spine subluxation in RA patients may be asymptomatic It is therefore essential to obtain a dynamic radiographic image of the cervical spine in order to diagnose cervical spine involvement and protect the patient from severe outcomes.The clinical trial registration number included in a the official document from Ministry of Higher Education and Science Research/Basrah University/Faculty of Medicine to Basrah Health Directorate/Research and Development Division is 72/3588 in 7 Jan 2017.

Keywords: Cervical spine instability; Iraq; Rheumatoid arthritis.

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Figures

Fig. 1
Fig. 1
Lateral dynamic cervical radiograph of sub-axial subluxation (a)) was measured anterior atlantodens interval (AADI). (b) was measured posterior atlantodens interval (PADI).
Fig. 2
Fig. 2
Superior migration of the odontoid (SMO) measured by Clark station method, the station of the atlas is determined by dividing the odontoid process into thirds in the sagittal plane.
Fig. 3
Fig. 3
Superior migration of the odontoid (SMO) measured by Ranawat criterion Diameter of the first cervical vertebra ring and distance from this diameter to the centre of the second cervical vertebra pedicle.
Fig. 4
Fig. 4
Sub-axial subluxation (SAS) was determined by measuring the vertebral body translation distance.
Fig. 5
Fig. 5
Frequency of radiographic changes in the cervical spine of 203 individuals with RA (atlanto-axial subluxation(AAS) in 11/203, combined superior migration of the odontoid (SMO)and atlantoaxial subluxation (AAS) in 1/203, combined sub-axial subluxation (SAS)and SMO and AAS in 2/203, combined SAS and AAS in1/203).
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