Respiratory abnormalities due to craniovertebral junction compression in rheumatoid disease.
OBJECTIVE
To assess the extent and severity of respiratory insufficiency associated with severe rheumatoid atlantoaxial dislocation and its relation to compression of the neuraxis.


METHODS
Twelve patients with severe atlantoaxial dislocation due to rheumatoid disease were studied. Detailed clinical, CT myelography and respiratory assessment including nocturnal oximetry, were performed on all patients.


RESULTS
All patients were severely disabled by their underlying disease but none had symptoms of hypoventilation. All the patients with C1 compression had myelopathic features. Those with medullary deformation (moulding and/or stretch) had abnormal noctural oximetry whilst no significant desaturations were seen in the remaining patients. Post-operative studies showed resolution of noctural desaturations.


CONCLUSIONS
This study suggests that clinically unsuspected respiratory insufficiency may be common in patients with severe medullary compression associated with rheumatoid atlantoaxial dislocation. It emphasises the importance of careful respiratory monitoring including nocturnal oxygen saturation in patients with major atlantoxial dislocation due to rheumatoid disease.
Howard
R S
RS
Harris Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Henderson
F
F
Hirsch
N P
NP
Stevens
J M
JM
Kendall
B E
BE
Crockard
H A
HA
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001268:Atlanto-Axial Joint / Q000293:injuries*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology*; D008297:Male; D008526:Medulla Oblongata; D008875:Middle Aged; D009192:Myelography; D009408:Nerve Compression Syndromes / Q000209:etiology*; D010092:Oximetry; D012131:Respiratory Insufficiency / Q000209:etiology*