Atlanto-axial instability in rheumatoid arthritis: a review

Abstract

Objectives: The purpose of this literature review is to identify common lesions present in the rheumatoid neck with specific emphasis to atlanto-axial instability, review its clinical presentation, imaging findings and management.

Study design: A review of the English medical literature was done with focus on recent studies that covered the presentation, diagnosis, management and clinical outcomes of rheumatoid arthritis of the cervical spine specifically atlantoaxial instability.

Data extraction: A comprehensive literature review of the English medical literature was obtained through PubMed up to 2015 was performed identifying relevant and more recent articles that addressed the presentation, evaluation, surgical management and outcomes of rheumatoid patients with atlanto-axial instability.

Data synthesis: Atlanto-axial instability is a very debilitating disease with high morbidity and mortality if untreated. Onset of myelopathy is a poor prognostic factor with poor long-term survival. High index of suspicion and early intervention results in good outcomes and prevents neurological outcome.

Conclusion: Cervical spine involvement in rheumatoid arthritis is common and debilitating. Atlanto-axial instability is the commonest form. Early diagnosis and treatment is key in management. Early selective choice of patients for surgery results in better outcomes.