Cervical spine instability and canal stenosis caused by rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that impacts on weakening ligaments, synovial arthritis and cartilage damage. The effect that can occur is instability and neural compression in the upper and sub-axial cervical.   The prevalence of atlantoaxial instability (AAI) around 40-80% among rheumatoid patients, but interesting to examine is the clinical symptoms that are not so visible despite radiologically instability confirmed on cervical spine. However, once the clinical symptoms of myelopathy occur, the mortality rate will increase sharply. We report a case of a 66 years old female who was admitted to our hospital with gait disturbance and weakness of her lower extremities. Radiographic evaluation of cervical spine showed erosive destruction of the odontoid process of C2, anterior atlantoaxial subluxation, and thickened yellow ligaments from C3 to C7. Surgery was performed, by removal of posterior arch of C1 and laminectomy C3 to C7, posterior occipito-cervical screw fixation from C3 to C7, combined with atlantoaxial transpedicular screw fixation. A sterno sub-occipitomandibular immobilization (SOMI) orthosis was applied for postoperative immobilization for 12 weeks. Improvement of motoric status noted after surgery.