Cervical spine manifestations of rheumatoid arthritis: a review

Nathan A. Shlobin*, Nader S. Dahdaleh

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.

Original languageEnglish (US)
Pages (from-to)1957-1965
Number of pages9
JournalNeurosurgical Review
Issue number4
StatePublished - Aug 2021


  • Atlantoaxial subluxation
  • Cervical spine
  • Cranial settling
  • Retroodontoid pannus
  • Rheumatoid arthritis
  • Subaxial subluxation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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