eMedicine Specialties > Radiology > Musculoskeletal

Rheumatoid Arthritis, Spine: Multimedia

Author: Michele Calleja, MD, FRCR, MRCP, Consultant Radiologist, Skeletal Radiology, Horton Hospital and NHS Treatment Centre, UK
Coauthor(s): Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Contributor Information and Disclosures

Updated: Mar 25, 2009

Multimedia

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Media file 1: Plain lateral radiograph of the normal cervical spine taken in extension shows measurement of anterior atlantodental interval (yellow line) and posterior atlantodental interval (red line).

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Plain lateral radiograph of the normal cervical spine taken in extension shows measurement of anterior atlantodental interval (yellow line) and posterior atlantodental interval (red line).

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Media file 2: Lateral flexion view of the cervical spine shows atlantoaxial subluxation.

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Lateral flexion view of the cervical spine shows atlantoaxial subluxation.

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Media file 3: Lateral view of the cervical spine in a patient with rheumatoid arthritis shows erosion of the odontoid process.

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Lateral view of the cervical spine in a patient with rheumatoid arthritis shows erosion of the odontoid process.

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Media file 4: T1-weighted sagittal MRI of the cervical spine shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.

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T1-weighted sagittal MRI of the cervical spine shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.

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Media file 5: Sagittal T2-weighted MRI of the cervical spine in the same case as in Image above. The compromised foramen magnum is easily appreciated, and there is increased signal intensity within the upper cord; this is consistent with compressive myelomalacia. Further narrowing of the canal is seen at multiple levels.

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Sagittal T2-weighted MRI of the cervical spine in the same case as in Image above. The compromised foramen magnum is easily appreciated, and there is increased signal intensity within the upper cord; this is consistent with compressive myelomalacia. Further narrowing of the canal is seen at multiple levels.

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Media file 6: Lateral radiograph of the same patient as in Images 4-5. Midcervical vertebral-body fusions are shown. The eroded peg is difficult to visualize, but inferior subluxation of the anterior arch of C1 is shown.

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Lateral radiograph of the same patient as in Images 4-5. Midcervical vertebral-body fusions are shown. The eroded peg is difficult to visualize, but inferior subluxation of the anterior arch of C1 is shown.

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Media file 7: Lateral radiograph of a normal cervical spine shows the McGregor line. The odontoid tip should not protrude more than 4.5 mm above the line, which is drawn from the posterior edge of the hard palate to the most caudal point of the occiput.

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Lateral radiograph of a normal cervical spine shows the McGregor line. The odontoid tip should not protrude more than 4.5 mm above the line, which is drawn from the posterior edge of the hard palate to the most caudal point of the occiput.

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Media file 8: Normal lateral magnified radiograph of the cervical spine shows the Ranawat method of detection of cranial settling. This method is used to measure the distance from the center of the pedicles (sclerotic ring) of C2 to a line drawn connecting the midpoints of the anterior and posterior arches of C1. (Normal values are 15 mm or greater for males and 13 mm or greater for females.)

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Normal lateral magnified radiograph of the cervical spine shows the Ranawat method of detection of cranial settling. This method is used to measure the distance from the center of the pedicles (sclerotic ring) of C2 to a line drawn connecting the midpoints of the anterior and posterior arches of C1. (Normal values are 15 mm or greater for males and 13 mm or greater for females.)

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Media file 9: Lateral radiograph of the cervical spine shows how the cervical height index (CHI) is calculated. The distance from the center of the sclerotic ring of C2 to the tip of the spinous process of C2 (dotted line) is measured. This is then divided into the distance from the center of the sclerotic ring of C2 to the mid-point of the inferior border of the body of C7. A CHI of less than 2 mm is a sensitive predictor of neurologic deficit.

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Lateral radiograph of the cervical spine shows how the cervical height index (CHI) is calculated. The distance from the center of the sclerotic ring of C2 to the tip of the spinous process of C2 (dotted line) is measured. This is then divided into the distance from the center of the sclerotic ring of C2 to the mid-point of the inferior border of the body of C7. A CHI of less than 2 mm is a sensitive predictor of neurologic deficit.

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References

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Resnick D, Kyriakos M, Greenway GD. Rheumatoid arthritis. In: Diagnosis of Bone and Joint Disorders. Vol 2. 4th ed. Philadelphia: WB Saunders;. 2002: 891-974.
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Keywords

spinal arthritis, spinal rheumatoid arthritis, spinal RA, early RA, early rheumatoid arthritis, erosion formation, pseudocyst formation, advanced RA, advanced rheumatoid arthritis, rheumatoid factor, RhF, course I rheumatoid arthritis, monocyclic rheumatoid arthritis, course II rheumatoid arthritis, polycyclic rheumatoid arthritis, course III rheumatoid arthritis, progressive rheumatoid arthritis, rheumatoid spondylitis, rheumatoid arthritis

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Contributor Information and Disclosures

Author

Michele Calleja, MD, FRCR, MRCP, Consultant Radiologist, Skeletal Radiology, Horton Hospital and NHS Treatment Centre, UK
Michele Calleja, MD, FRCR, MRCP is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Coauthor(s)

Geoff Hide, MBBS, MRCP, FRCR, Consultant Musculoskeletal Radiologist, Department of Radiology, Freeman Hospital; Honorary Clinical Lecturer, Faculty of Medical Sciences, University of Newcastle upon Tyne
Geoff Hide, MBBS, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Amilcare Gentili, MD, Clinical Professor of Radiology, University of California at San Diego; Consulting Staff, Department of Radiology, Thornton Hospital
Amilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, and Society of Skeletal Radiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Lynne S Steinbach, MD, Chief of Musculoskeletal Radiology, Professor, Department of Radiology, University of California at San Francisco
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, EdM, Professor, Department of Radiology, Vice Chairman for Radiology Informatics, Section Head of Musculoskeletal Radiology, University of Washington
Felix S Chew, MD, MBA, EdM is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Musculoskeletal

Rheumatoid Arthritis, Spine: Multimedia

Multimedia

Plain lateral radiograph of the normal cervical spine taken in extension shows measurement of anterior atlantodental interval (yellow line) and posterior atlantodental interval (red line).

Lateral flexion view of the cervical spine shows atlantoaxial subluxation.

Lateral view of the cervical spine in a patient with rheumatoid arthritis shows erosion of the odontoid process.

Lateral radiograph of the same patient as in Images 4-5. Midcervical vertebral-body fusions are shown. The eroded peg is difficult to visualize, but inferior subluxation of the anterior arch of C1 is shown.

Lateral radiograph of a normal cervical spine shows the McGregor line. The odontoid tip should not protrude more than 4.5 mm above the line, which is drawn from the posterior edge of the hard palate to the most caudal point of the occiput.

More on Rheumatoid Arthritis, Spine

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor