Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 106. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 1054 Section Tumors and Inflammation Recapitulation Epidemiology. Approximately 40 of patients with rheumatoid arthritis show pathology in the cervical spine mainly the atlantoaxial segment. Pathogenesis. The translational instability between axis and atlas might be painful and leads in the long term to myelopathic changes due to chronic traumatization of the myelon. Ongoing osseous resorption of the lateral masses of the atlas causes upward migration of the dens into the foramen magnum. In the subaxial cervical spine the inflammatory process causes instability and deformity. Clinical presentation. The instability and deformity are mostly associated with the corresponding clinical symptoms pain and neurological signs in different stages. However it has to be kept in mind that these patients are used to tolerating pain and that often other problems of the joints are more prominent. The pathology of the cervical spine may progress unnoticed in these cases. Diagnostic work-up. Every patient with RA should have a lateral flexion radiography of the cervical spine performed as a screening investigation at least every 3-5 years according to the aggressivity of the disease . In cases of manifest instability or deformity a neurophysiological work-up and MRI should be performed. Non-operative treatment. If surgery is not indicated the patient should be given regular observation with neurophysiological examinations radiographs and MRI. Operative treatment. Neck pain is the most common indication for surgery but neurological symptoms with myelopathy or radicular deficits might be the primary cause for surgery. It should be kept in mind that clinical assessment in rheumatoid patients might be extremely difficult since previous surgery on various articulations of the extremities makes interpretation of clinical findings difficult. Neurophysiological investigation is a suitable means for obtaining objective results. Stabilization of the atlantoaxial segment is the most common .
