This 2005 narrative review by Kim and Hilibrand synthesizes the pathophysiology, natural history, diagnostic criteria, and surgical management of rheumatoid arthritis involving the cervical spine, addressing when to image, when to operate, and what outcomes to expect across the three distinct instability patterns.
When an RA patient presents with new neck pain or myelopathy signs, obtain flexion-extension cervical radiographs and measure the posterior atlantodental interval — a PADI ≤14 mm, any atlantoaxial impaction, or subaxial canal ≤14 mm mandates MRI and prompt surgical consultation, because waiting until neurologic deficit is severe significantly worsens operative outcomes.
This 2005 narrative review by Kim and Hilibrand synthesizes the pathophysiology, natural history, diagnostic criteria, and surgical management of rheumatoid arthritis involving the cervical spine, addressing when to image, when to operate, and what outcomes to expect across the three distinct instability patterns.
When an RA patient presents with new neck pain or myelopathy signs, obtain flexion-extension cervical radiographs and measure the posterior atlantodental interval — a PADI ≤14 mm, any atlantoaxial impaction, or subaxial canal ≤14 mm mandates MRI and prompt surgical consultation, because waiting until neurologic deficit is severe significantly worsens operative outcomes.