Castro S, Verstraete K, Mielants H, Vanderstraeten G, de Reuck J, Veys E M
Department of Rheumatology, University Hospital, Ghent, Belgium.
Clin Exp Rheumatol. 1994 Jul-Aug;12(4):369-74.
This study was designed to reveal any correlation between radiological signs and clinical findings of cervical spine involvement in rheumatoid arthritis (RA).
Fifty patients with definite rheumatoid arthritis were evaluated for cervical spine involvement by a clinical neurological examination, a somatosensory evoked potential (SEP) study and different radiological techniques including tomograms, computerized tomography (CT) and magnetic resonance imaging (MRI).
Anterior atlantoaxial subluxation was a common finding, frequently associated with superior migration of the dens and subaxial subluxation. Two patients presented a posterior atlantoaxial subluxation due to complete erosion of the dens. Both had cervical cord compression and one of them had hypoglossal nerve paresis. The delineation of peridental pannus formation was clearly demonstrated by MRI. In the majority of cases cervical cord compression was caused by pannus formation or by vertical atlantoaxial subluxation.
The correlation between the severity of the radiological findings and the clinical-neurological signs was poor. A 4-limb SEP study appeared to be a useful screening method for the detection of cervical medullary compression.
本研究旨在揭示类风湿关节炎（RA）颈椎受累的放射学征象与临床发现之间的相关性。
通过临床神经学检查、体感诱发电位（SEP）研究以及包括断层扫描、计算机断层扫描（CT）和磁共振成像（MRI）在内的不同放射学技术，对50例确诊为类风湿关节炎的患者进行颈椎受累情况评估。
寰枢椎前脱位是常见表现，常伴有齿状突上移和下颈椎半脱位。2例患者因齿状突完全侵蚀出现寰枢椎后脱位。二者均有颈髓受压，其中1例有舌下神经麻痹。MRI清晰显示了牙周血管翳形成。在大多数病例中，颈髓受压是由血管翳形成或寰枢椎垂直半脱位引起的。
放射学表现的严重程度与临床神经学体征之间的相关性较差。四肢SEP研究似乎是检测颈髓受压的一种有用的筛查方法。
