title: Rheumatoid cervical myelopathy.
abstract: The mode of presentation and the factors which influenced the diagnosis and outcome in 31 patients with rheumatoid cervical myelopathy were reviewed. The presenting features included paraesthesiae and /or numbness (23 cases) weakness (six) flexor spasms (five) and incontinence (two). Isolated sensory loss presenting in a glove and stocking distribution was often misdiagnosed as a peripheral neuropathy. Multiple neurological deficits were eventually present in all patients and included spastic quadriparesis (17), spastic paraparesis (seven), bladder disturbance (nine), and cranial nerve deficits (six). Twenty-seven patients had impaired light touch and pin prick sensation but the sensory level did not correlate with the presumed level of spinal cord compressions. Twenty-one patients had dissociation between loss of position and vibration sensation. All patients had one or more cervical luxations; five patients had atlanto-axial luxation alone, five had subaxial luxation alone and the remainder multiple luxations. Neurological improvement was more frequent and of longer duration in those treated by occipito-cervical fusion than in those treated conservatively but fitness for surgery may have selected a group with a better prognosis.
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011859:Radiography; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging; D013997:Time Factors