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Craniocervical junction involvement in ankylosing spondylitis.

Gleb Slobodin^1,2, Arsen Shpigelman³, Hanna Dawood⁴

¹Department of Internal Medicine A, Bnai Zion Medical Center, PO Box 4940, 31048, Haifa, Israel. gslobodin@yahoo.com.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|May 11, 2015

Summary

Computed tomography (CT) reveals frequent craniocervical junction (CCJ) involvement in ankylosing spondylitis (AS) patients. Both joints and ligaments of the CCJ are commonly affected, even with varying disease severity.

Keywords:

Ankylosing spondylitis Computed tomography Craniocervical junction Spine

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Area of Science:

Rheumatology
Radiology
Orthopedics

Background:

Conventional radiography has limitations in visualizing craniocervical junction (CCJ) structures.
Ankylosing spondylitis (AS) can affect the CCJ, but detailed imaging findings are not well-established.

Purpose of the Study:

To characterize the spectrum of computed tomography (CT) findings in the CCJ of patients with AS.
To assess the prevalence and nature of CCJ involvement in AS using CT.

Main Methods:

CT scans of the cervical spine were analyzed in 11 AS patients and 33 controls.
Anatomic CCJ intervals were measured and compared to normal standards.
Pathological findings were described, localized, and related to CCJ joints and ligaments.

Main Results:

All AS patients (male, median age 48) showed CCJ disease-related changes.
Atlanto-occipital joints (8/11) and atlanto-dental articulation (3/11) were affected.
Enthesopathy of the CCJ was observed in 7/11 patients.

Conclusions:

The CCJ is frequently involved in AS, particularly in advanced disease.
CT demonstrates that both articulations and ligaments of the CCJ can be affected in AS.
CCJ involvement in AS may be independent of the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).