Chérié Lignière G, Montagnani G, Panarace G, Gualdi I
Dept. of Rheumatology, G. Pini Orthopaedic Institute, Milan.
Clin Exp Rheumatol. 1988 Oct-Dec;6(4):343-6.
Cervical myelopathy is found fairly often with rheumatoid arthritis. It is one of the worst complications of the disease and can lead to tetraplegia or even to sudden death. However, when we consider the high incidence of involvement of the cervical spine in rheumatoid arthritis, the number of cases of cervical myelopathy, even of slight degree, is not very high. We have used magnetic resonance to identify the condition of the cervical structures, especially the nerve structures, in 15 patients with rheumatoid arthritis, with involvement of the cervical articulations but without neurological symptoms. We found anterior compression of the spinal cord caused by the odontoid process of the epistropheus in 13 cases. One case had lateral deviation of the spinal cord and another had compression of a vertebral artery. In another the lumen of the nasopharynx was decreased and one had posterior compression of the spinal cord by the posterior arch of the atlas. Magnetic resonance also makes it possible to detect a rheumatoid pannus on the affected articulations. We conclude that magnetic resonance is at present a useful instrument for evaluation of the presence of cervical myelopathy in rheumatoid arthritis patients, to prevent more serious complications.
颈椎脊髓病在类风湿关节炎中较为常见。它是该疾病最严重的并发症之一，可导致四肢瘫痪甚至猝死。然而，考虑到类风湿关节炎中颈椎受累的高发生率，即使是轻度的颈椎脊髓病病例数量也不算很高。我们对15例颈椎关节受累但无神经症状的类风湿关节炎患者进行了磁共振检查，以确定颈椎结构尤其是神经结构的状况。我们发现13例患者的脊髓受到枢椎齿突的前方压迫。1例患者脊髓出现侧偏，另1例患者椎动脉受压。还有1例患者鼻咽腔变窄，1例患者脊髓受到寰椎后弓的后方压迫。磁共振还能够检测出受累关节处的类风湿血管翳。我们得出结论，目前磁共振是评估类风湿关节炎患者颈椎脊髓病存在情况的有用工具，有助于预防更严重的并发症。
