Rheumatoid arthritis

Neuroanatomy, compression, and grading of deficits

Seth M. Zeidman, Thomas B. Ducker

Research output: Contribution to journalArticle

Abstract

Study Design. The authors summarize published data regarding cervical spine involvement in rheumatoid arthritis, define the neurologic manifestations, and provide recommendations for management of these complex and difficult problems. Objectives. The authors attempted to accurately define the neurologic lesions resulting from rheumatoid involvement of the cervical spine despite the complexity of the neuroanatomy of the cervicomedullary region and the diversity of pathology. Summary of Background Data. Despite the longstanding recognition of cervical spine involvement in rheumatoid arthritis, appreciation of the different neurologic manifestations of this disease has been lacking or misunderstood. Methods. The authors reviewed the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions that interact to create these complex and often confusing clinical situations. Results. Rheumatoid arthritis produces encroachment on the brainstem and cervical spinal cord. The minimum space available at the craniocervical junction for the neural structures is 13 to 14 mm, which is fairly constant. Below C2, the available space is only 12 mm. When the amount of space reduced below this amount, there is, by definition, neural compression. The site of compression and/or repeated microcontusions will determine subsequent neurologic deficits. At the craniovertebral junction, neural compression and traumatic injury typically occur anteriorly at the pyramidal decussation producing cruciate paralysis with considerable weakness in both arms and minimal leg involvement. Cranial settling can result in lower medulla and cranial nerve dysfunction. Subaxial stenosis typically results in a more typical myelopathy. Conclusions. Accurate diagnostic studies are mandated to determine the location of compression and to fully appreciate the resultant neurologic deficits. To improve more complete comprehension of the neurologic manifestations of rheumatoid arthritis, the relevant neuroanatomy, neurovascular anatomy, and neuropathologic lesions must be understood.

Original languageEnglish (US)
Pages (from-to)2259-2266
Number of pages8
JournalSpine
Volume19
Issue number20
StatePublished - 1994

Fingerprint

Neuroanatomy
Neurologic Manifestations
Rheumatoid Arthritis
Spine
Anatomy
Pyramidal Tracts
Cranial Nerves
Spinal Cord Diseases
Nervous System Diseases
Paralysis
Nervous System
Brain Stem
Leg
Pathologic Constriction
Arm
Pathology
Wounds and Injuries

Keywords

  • Atlantoaxial subluxation
  • Cervical spinal
  • Myelopathy
  • Rheuma- toid arthritis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Physiology

Cite this

Zeidman, S. M., & Ducker, T. B. (1994). Rheumatoid arthritis: Neuroanatomy, compression, and grading of deficits. Spine, 19(20), 2259-2266.

Rheumatoid arthritis : Neuroanatomy, compression, and grading of deficits. / Zeidman, Seth M.; Ducker, Thomas B.

In: Spine, Vol. 19, No. 20, 1994, p. 2259-2266.

Research output: Contribution to journalArticle

Zeidman, SM & Ducker, TB 1994, 'Rheumatoid arthritis: Neuroanatomy, compression, and grading of deficits', Spine, vol. 19, no. 20, pp. 2259-2266.
Zeidman, Seth M. ; Ducker, Thomas B. / Rheumatoid arthritis : Neuroanatomy, compression, and grading of deficits. In: Spine. 1994 ; Vol. 19, No. 20. pp. 2259-2266.
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