Slobodin Gleb, Shpigelman Arsen, Dawood Hanna, Rimar Doron, Croitoru Simona, Boulman Nina, Rozenbaum Michael, Kaly Lisa, Rosner Itzhak, Odeh Majed
Department of Internal Medicine A, Bnai Zion Medical Center, PO Box 4940, 31048, Haifa, Israel.
Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
Eur Spine J. 2015 Dec;24(12):2986-90. doi: 10.1007/s00586-015-3994-y. Epub 2015 May 10.
Available studies of craniocervical junction (CCJ) involvement in ankylosing spondylitis (AS) are based on conventional radiography, which has limited ability in the definition of many elements of the CCJ. The goal of the present study was to describe the spectrum of computed tomography (CT) findings in the CCJ in a cohort of patients with AS.
CT scans of the cervical spine of 11 patients with AS and 33 control subjects were reviewed, and imaging findings related to the CCJ were assessed. The standard anatomic intervals describing the CCJ were measured and compared to accepted normal standards. Findings representing pathology were described, categorized by localization, and relation to joints or ligaments of the CCJ.
All AS patients were males with median age of 48 years and median disease duration of 20 years. The calculated median-modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) for the cervical spine was 8.5 ranging from 0 to 27. Disease-related changes in one or more elements of the CCJ were detected in all patients. Atlanto-occipital joints were involved in 8 patients, while 3 patients had disease of the atlanto-dental articulation. Enthesopathy of the CCJ was observed in 7 patients.
The CCJ is frequently involved in AS patients with advanced disease and may be independent on the mSASSS. Both articulations and ligaments of CCJ may be affected in AS patients.
现有关于强直性脊柱炎（AS）颅颈交界区（CCJ）受累情况的研究基于传统放射学检查，其在界定CCJ诸多结构方面的能力有限。本研究的目的是描述一组AS患者CCJ的计算机断层扫描（CT）表现。
回顾了11例AS患者和33例对照者的颈椎CT扫描图像，评估与CCJ相关的影像学表现。测量描述CCJ的标准解剖间隙，并与公认的正常标准进行比较。描述代表病变的表现，按部位分类，并确定其与CCJ关节或韧带的关系。
所有AS患者均为男性，中位年龄48岁，中位病程20年。颈椎的计算中位改良斯托克强直性脊柱炎脊柱评分（mSASSS）为8.5，范围为0至27。所有患者均检测到CCJ一个或多个结构的疾病相关改变。8例患者寰枕关节受累，3例患者寰齿关节患病。7例患者观察到CCJ附着点病。
晚期AS患者的CCJ常受累，且可能与mSASSS无关。AS患者的CCJ关节和韧带均可受累。
