RHEUMATOID CERVICAL MYELOPATHY

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  • 1 January 1981
    • journal article
    • research article
    • Vol. 50  (199) , 307-319
Abstract
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 paraesthesias and/or numbness (23 cases), weakness (6), flexor spasms (5) and incontinence (2). 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 (7), bladder disturbance (9) and cranial nerve deficits (6). 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 compression. Twenty-one patients had dissociation between loss of position and vibration sensation. All patients had > 1 cervical luxation; 5 patients had atlanto-axial luxation alone, 5 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.

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