Tiến sĩ Kim IS trợ lý giáo sư lâm sàng Phẫu thuật chỉnh hình, phẫu thuật chỉnh hình Khoa, Đại học Tufts học Y khoa, Boston, MA, và Tập đoàn Boston cột sống, Bệnh viện Baptist New England, Boston. Tiến sĩ Hilibrand IS Phó giáo sư, Sở Phẫu thuật chỉnh hình và phẫu thuật thần kinh, | Rheumatoid Arthritis in the Cervical Spine David H. Kim MD and Alan S. Hilibrand MD Dr. Kim is Assistant Clinical Professor of Orthopaedic Surgery Department of Orthopaedic Surgery Tufts University School of Medicine Boston MA and The Boston Spine Group New England Baptist Hospital Boston. Dr. Hilibrand is Associate Professor Departments of Orthopaedic Surgery and Neurosurgery and Director of Medical Education for the Department of Orthopaedic Surgery Jefferson Medical College Thomas Jefferson University Philadelphia PA and The Rothman Institute Philadelphia. None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article Dr. Kim and Dr. Hilibrand. Reprint requests Dr. Hilibrand The Rothman Institute 925 Chestnut Street Philadelphia PA 19107-4216. J Am Acad Orthop Surg 2005 13 463-474 Copyright 2005 by the American Academy of Orthopaedic Surgeons. Abstract The cervical spine often becomes involved early in the course of rheumatoid arthritis leading to three different patterns of instability atlantoaxial subluxation atlantoaxial impaction and subaxial subluxation. Although radiographic changes are common the prevalence of neurologic injury is relatively low. The primary goal of treatment is to prevent permanent neurologic injury while avoiding potentially dangerous and unnecessary surgery. Strategies include patient education lifestyle modification regular radiographic follow-up and early surgical intervention when indicated. Magnetic resonance imaging is indicated when neurologic deficit myelopathy occurs or when plain radiographs show atlantoaxial subluxation with a posterior atlantodental interval 14 mm any degree of atlantoaxial impaction or subaxial stenosis with a canal diameter 14 mm. Surgery should be considered promptly for any of the following progressive neurologic deficit chronic neck pain
