Rheumatoid cervical myelopathy

The mode of presentation and the factors which influenced the diagnosis and outcome in 31 patients with rheumatoid cervical myelopathy were reviewed. The presenting features included paraesthesiae and /or numbness (23 cases) weakness (six) flexor spasms (five) and incontinence (two). Isolated sensory loss presenting in a glove and stocking distribution was often misdiagnosed as a peripheral neuropathy. Multiple neurological deficits were eventually present in all patients and included spastic quadriparesis (17), spastic paraparesis (seven), bladder disturbance (nine), and cranial nerve deficits (six). Twenty-seven patients had impaired light touch and pin prick sensation but the sensory level did not correlate with the presumed level of spinal cord compressions. Twenty-one patients had dissociation between loss of position and vibration sensation. All patients had one or more cervical luxations; five patients had atlanto-axial luxation alone, five had subaxial luxation alone and the remainder multiple luxations. Neurological improvement was more frequent and of longer duration in those treated by occipito-cervical fusion than in those treated conservatively but fitness for surgery may have selected a group with a better prognosis.