Presentation
History of rheumatoid arthritis presented with neck pain, upper and lower limb weakness
Patient Data
The anterior arch of the C1 is displaced anteriorly compared to the dens of the C2 with increased distance between them indicating atlanto-axial subluxation.
Posterior displacement of the dens with subsequent narrowing of the cervical spinal canal at this level.
Narrowing of the distance between the dens and left lateral mass of C1 compared to the distance of the dens and the right lateral mass of C1, reflecting left rotatory subluxation of the dens of C2.
Presence of pre-dental pannus of low SI in all pulses between the anterior arch of C1 and dens of the C2.
The transverse ligament is thin and stretched by the posteriorly subluxated dense but still intact.
Backward displacement of the dens of C2 with subsequent narrowing of the cervical spinal canal compressing the spinal cord between the dens and posterior arch of C1 with thinning of the cord at this level with focal intramedullary area of high T2 and STIR SI inside suggesting compressive myelopathy.
Case Discussion
Atlanto-axial subluxation is a common complication of Rheumatoid arthritis occurring secondary to predental pannus formation which fills the space between the dens of C2 and the anterior arch of the C1 causing subsequent posterior displacement of the dens and increased atlanto-axial distance.
Atlanto-axial subluxation can cause narrowing of the spinal canal like in this case with subsequent compressive myelopathy.
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