Atraumatic odontoid fractures in patients with rheumatoid arthritis.

BACKGROUND CONTEXT

Instability of the cervical spine is a common problem in patients with rheumatoid arthritis. The natural course of rheumatoid arthritis in the cervical spine is well documented. However, the true prevalence of occult fractures of the odontoid process in patients with rheumatoid arthritis is not known.

PURPOSE

To draw attention to the possibility of occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis.

STUDY DESIGN

We report on two cases with previously unrecognized fractures of the odontoid process.

METHODS

In this case series, we review the individual radiographic findings and clinical observations in two rheumatoid patients in whom a fracture of the odontoid process was diagnosed.

RESULTS

Each one of these two rheumatoid patients had an unrecognized fracture of the odontoid process without any prior history of trauma. Their fracture was identified serendipitously during workup for neck pain.

CONCLUSIONS

Occult, atraumatic fractures of the odontoid process may be found in patients with long-standing rheumatoid arthritis. This injury should be suspected if previously asymptomatic patients complain about new onset of neck pain without significant trauma.