Cervical spine complications in rheumatoid arthritis patients - Awareness is the key to averting serious consequences

Neck pain in a patient with rheumatoid arthritis can be an important clue to serious cervical spine involvement. Loss of articular cartilage, ligamentous laxity, and bone erosion can lead to potentially fatal spinal cord instability in these patients. The most common structural manifestations of such changes are atlantoaxial instability, cranial settling, and subaxial cervical instability. Periodontoid pannus formation can cause life-threatening high cervical myelopathy. In this article, Drs Alberstone and Benzel describe a goal-oriented approach to management of these complications.