Early diagnosis of rheumatoid cervical myelopathy

The purpose of this study was to detect early signs of cervical myelopathy on the basis of clinical finding, radiographs, somatosensory evoked potentials (SSEPs) for n. medianus in 56 patients and transcranial dopler (TCD) for vertebral arteries in 35 patients. Radiological findings, SSEPs, and TCD were registered in neutral and functional scanning positions. Forward AA dislocation was verified in 25 patients with mean value 4.7 mm. The total of 12 (3 in neutral and 9 in functional positions) out of 56 patients had pathological findings of SSEPs for n. medianus. Out of 35 patients 13 (8 in standard imaging position and 5 in rotations) had abnormal values of mean blood flow velocities (MBFV). Movements can provoke neural conduction disturbances through spinal cord and interrupt vertebral arteries blood flow. The early detection of the cervical myelopathy is possible when changing the head position during SSEPs and TCD recordings. On the basis of clinical, x-ray, SSEPs and TCD analyses we suggest that patients with risk of developing myelopathy should be separated.