Nonreducible rotational head tilt and atlantoaxial lateral mass collapse. Clinical and roentgenographic features in patients with juvenile rheumatoid arthritis and ankylosing spondylitis

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Abstract
Nonreducible rotational head tilt resulting from predominantly unilateral collapse of the lateral mass of the atlas (C1) and/or axis (C2) has been characterized in patients with rheumatoid arthritis. An identical phenomenon is reported in 5 patients with juvenile rheumatoid arthritis (JRA) and in 6 with ankylosing spondylitis (AS). Most patients had neck pain and crepitus, all had a fixed head tilt deformity and most also had a rotational deformity. Roentgenographically, all had predominantly unilateral collapse of the lateral masses of C1 and/or C2, and the head always tilted toward the most collapsed side. The patients with JRA had polyarticular disease of long duration and generally mild neck symptoms, with only 1 requiring neck surgery for pain. The patients with AS tended to have proximal peripheral joint involvement and long-standing disease with more severe neck symptoms; 4 underwent posterior cervical fusion for intractable pain. None of the 11 patients had demonstrable neurologic deficits.