Jose A. Narvaez, Abstract Co-Author: Nothing to Disclose

Javier Narváez MD, Abstract Co-Author: Nothing to Disclose

Matias De Albert, Presenter: Nothing to Disclose

Javier Hernandez Gañan, Abstract Co-Author: Nothing to Disclose

Pablo Vera MD, Abstract Co-Author: Nothing to Disclose

Idoia Santos MD, Abstract Co-Author: Nothing to Disclose

To investigate the prevalence of vertebral ankylosis (VA) in a series of patients with Rheumatoid Arthritis (RA) and symptomatic involvement of the cervical spine.

Forty one consecutive patients with RA and symptomatic cervical spine involvement were studied with radiographs and cervical spine MR imaging. The patients were 33 women and 8 men; mean age at time of the study was 59 years (range, 23-82 years) and the mean disease duration was 18.9 ± 19.2 years (range, 4 to 40 years). Vertebral ankylosis (VA) was defined on MR imaging as reemplacement of intervertebral disc by bone marrow or cortical marrow. VA was classified as partial or complete, and disc levels involved were recorded. Other MR findings analized were: synovitis and erosions at the atlantoaxial joint; in addition vertebral bone marrow edema, spinal canal stenosis, medullary cord compression and medullary cord signal intensity changes of myelopathy were evaluated on MR images at both atlantoaxial and subaxial levels.  Comparisons between patient’s groups with and without VA were made using the Student’s t-test for independent continuous variables or the Mann-Whitney U test. To analyze categorical data we performed the chi-square test for trend and the Fisher exact test.  

Vertebral ankylosis (VA) was observed in 24.4% (10/41) of the patients: at one disc level in 4 cases (9.75%), at two levels in 2 (4.9%), at three levels in 1 (2.4%), and at four levels in 3 (7.3%). Of the total amount of 23 VA, ankylosis was partial in 87% of cases and complete in 17%. Sites of VA were: C3-C4 (26%), C4-C5 (26%), C5-C6 (17%), C6-C7 (17%), C7-D1 (9%) and C2-C3 (5%). Patients with VA present more frequently subaxial cord compression (p = 0.04), and  subaxial signal intensity changes of myelopathy (p = 0.05) on MR imaging.  There were not correlation between VA and the presence of MR signs of inflammatory activity (erosions or synovitis at atlantoaxial joint, bone marrow edema).   

Cervical VA is not uncommon in symptomatic RA patients. In our experience, its presence is associated with subaxial cord compression and signal intensity changes of myelopathy on MR imaging.

Cervical VA is not uncommon in symptomatic RA patients.  Recognition of VA in these patients is important because, in our experience, it seems related with subaxial cord compression on MR images.

Narvaez, J, Narváez, J, De Albert, M, Hernandez Gañan, J, Vera, P, Santos, I, Cervical Spinal Ankylosis on MR imaging of Symptomatic Rheumatoid Arthritis Patients .  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008575.html