title: [Instability of the upper cervical spine due to rheumatism].
abstract: Rheumatic manifestation at the cervical spine occurs in more than 50% of all cases in the natural course of this disease. The first cervical manifestation takes place in the upper cervical spine. The initial involvement of the C1/C2 segment leads to atlantodental subluxation. Progressive destruction can result in vertical instability, which is characterized by cranial subluxation of the odontoid process with the danger of resulting stenosis and cervical myelopathy. The goal of diagnosis has to be the early recognition of these changes to establish an effective treatment protocol. Persistent pain, neurological deficits, and progressive radiological signs for instability are indications for operative stabilizing procedures. These procedures avoid progressive destruction and improve the prognosis regarding pain decrease, regression of neurological deficits, and life expectancy.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Charité, Campus Benjamin Franklin, Universitätsmedizin, Berlin. christoph.heyde@charite.de
authors.forename: C E
authors.initials: CE
authors.lastname: Heyde
authors.forename: U
authors.initials: U
authors.lastname: Weber
authors.forename: R
authors.initials: R
authors.lastname: Kayser
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery; D002574:Cervical Vertebrae; D002985:Clinical Protocols; D018450:Disease Progression; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008017:Life Expectancy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011542:Pseudarthrosis / Q000209:etiology / Q000601:surgery; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000209:etiology; D013122:Spinal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D013123:Spinal Fusion; D013997:Time Factors; D014057:Tomography, X-Ray Computed