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Rheumatoid cervical myelopathy

J S Marks, J Sharp

    The Quarterly Journal of Medicine
    |January 1, 1981
    PubMed
    Summary
    This summary is machine-generated.

    Rheumatoid cervical myelopathy often presents with sensory loss, mimicking peripheral neuropathy. Occipito-cervical fusion showed better outcomes than conservative treatment for this spinal cord condition.

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    Area of Science:

    • Neurology
    • Rheumatology
    • Spinal Surgery

    Background:

    • Rheumatoid cervical myelopathy (RCM) is a severe complication of rheumatoid arthritis affecting the cervical spine.
    • Early diagnosis and appropriate management are crucial for preventing irreversible neurological damage.

    Observation:

    • 31 patients with RCM were reviewed for presentation, diagnosis, and outcomes.
    • Common presenting symptoms included paresthesia, numbness, weakness, flexor spasms, and incontinence.
    • Isolated sensory loss was frequently misdiagnosed as peripheral neuropathy.

    Findings:

    • All patients exhibited cervical luxations (atlanto-axial, subaxial, or multiple).
    • Neurological deficits included spastic quadriparesis, paraparesis, bladder disturbance, and cranial nerve deficits.

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  • Sensory level did not correlate with spinal cord compression; dissociation of sensation was common.

    • Implications:

    • Occipito-cervical fusion demonstrated superior neurological improvement and longer-lasting effects compared to conservative management.
    • Patient fitness for surgery might influence observed outcomes, suggesting a potential selection bias.
    • Accurate diagnosis of RCM is critical to differentiate it from peripheral neuropathies and ensure timely intervention.