Lee H S, Kim T H, Yun H R, Park Y W, Jung S S, Bae S C, Joo K B, Kim S Y
Hospital for Rheumatic Disease, Hanyang University, Seoul, Korea.
Clin Rheumatol. 2001;20(4):262-6. doi: 10.1007/s100670170041.
Ankylosing spondylitis (AS) is characterised by its effects on the axial skeleton. The cervical spine is also vulnerable to the disease process. Our aim was to determine the frequency of radiologic changes to the cervical spine and their correlation with clinical variables. We also used the Bath Ankylosing Spondylitis Radiology Index (BASRI) system, which is one of the reliable scoring systems of radiography, to score the global radiologic changes to the cervical and lumbar spine and the hip joints in our AS cohort. There were 181 patients with anteroposterior and lateral full-flexion views on radiography of the cervical spine here included in the study. A radiologist examined the radiologic changes to all anatomical compartments of the cervical spine in detail and graded them according to the BASRI system. We used the clinical and demographic data of our AS cohort to determine their relation to the radiographic changes. Eighty-eight patients (48.6%) showed radiological changes to the cervical spine; to the discovertebral joint 35.9%; the apophyseal joint 26.0%; atlantoaxial articulation 22.1% (atlantoaxial subluxation 13.8%); the costovertebral joint 18.2%; and to the posterior ligamentous attachment 11.6%. Using the BASRI system, 73 patients (40.3%) showed radiologic changes to the cervical spine and were graded as score 1 (1.7%), 2 (22.7%), 3 (6.6%) or 4 (9.4%). Among those graded as normal by the BASRI system, 17 showed some changes the cervical spine, such as atlantoaxial joint subluxation or narrowing, and severe osteoporosis with no other radiographic changes. Current age, disease duration, inflammatory back pain and cervical symptoms were associated with the radiographic changes to the cervical spine. The BASRI-cervical spine score correlated with the BASRI-lumbar spine and hip joint score, sacroiliitis, disease duration, and duration of inflammatory back pain and cervical symptoms. Our data suggest that radiographic changes to the cervical spine are frequent in AS, and can be predicted in the patients with old age, long duration of disease and inflammatory back pain, and cervical symptoms. Also, the BASRI scoring system showed similar results as a detailed assessment of the cervical spine in our study.
强直性脊柱炎（AS）的特点是对中轴骨骼产生影响。颈椎也易受该病进程的影响。我们的目的是确定颈椎放射学改变的频率及其与临床变量的相关性。我们还使用了巴斯强直性脊柱炎放射学指数（BASRI）系统，该系统是可靠的放射学评分系统之一，用于对我们AS队列中颈椎、腰椎和髋关节的整体放射学改变进行评分。本研究纳入了181例颈椎X线前后位和侧位全屈位片的患者。一名放射科医生详细检查了颈椎所有解剖部位的放射学改变，并根据BASRI系统对其进行分级。我们使用AS队列的临床和人口统计学数据来确定它们与放射学改变的关系。88例患者（48.6%）显示颈椎有放射学改变；椎体间关节为35.9%；关节突关节为26.0%；寰枢关节为22.1%（寰枢椎半脱位为13.8%）；肋椎关节为18.2%；后韧带附着处为11.6%。使用BASRI系统，73例患者（40.3%）显示颈椎有放射学改变，并被评为1分（1.7%）、2分（22.7%）、3分（6.6%）或4分（9.4%）。在BASRI系统评定为正常的患者中，17例显示颈椎有一些改变，如寰枢关节半脱位或狭窄，以及严重骨质疏松且无其他放射学改变。当前年龄、病程、炎性背痛和颈部症状与颈椎的放射学改变相关。BASRI颈椎评分与BASRI腰椎和髋关节评分、骶髂关节炎、病程以及炎性背痛和颈部症状的持续时间相关。我们的数据表明，AS患者颈椎的放射学改变很常见，在老年、病程长、有炎性背痛和颈部症状的患者中可以预测到。此外，在我们的研究中，BASRI评分系统显示的结果与对颈椎的详细评估相似。
