title: Craniocervical junction involvement in ankylosing spondylitis.
abstract: OBJECTIVE
  Available studies of craniocervical junction (CCJ) involvement in ankylosing spondylitis (AS) are based on conventional radiography, which has limited ability in the definition of many elements of the CCJ. The goal of the present study was to describe the spectrum of computed tomography (CT) findings in the CCJ in a cohort of patients with AS.
  
  
  METHODS
  CT scans of the cervical spine of 11 patients with AS and 33 control subjects were reviewed, and imaging findings related to the CCJ were assessed. The standard anatomic intervals describing the CCJ were measured and compared to accepted normal standards. Findings representing pathology were described, categorized by localization, and relation to joints or ligaments of the CCJ.
  
  
  RESULTS
  All AS patients were males with median age of 48 years and median disease duration of 20 years. The calculated median-modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) for the cervical spine was 8.5 ranging from 0 to 27. Disease-related changes in one or more elements of the CCJ were detected in all patients. Atlanto-occipital joints were involved in 8 patients, while 3 patients had disease of the atlanto-dental articulation. Enthesopathy of the CCJ was observed in 7 patients.
  
  
  CONCLUSIONS
  The CCJ is frequently involved in AS patients with advanced disease and may be independent on the mSASSS. Both articulations and ligaments of CCJ may be affected in AS patients.
authors.affiliation: Department of Internal Medicine A, Bnai Zion Medical Center, PO Box 4940, 31048, Haifa, Israel. gslobodin@yahoo.com.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. gslobodin@yahoo.com.
authors.forename: Gleb
authors.initials: G
authors.lastname: Slobodin
authors.affiliation: Department of Orthopedic Surgery, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Arsen
authors.initials: A
authors.lastname: Shpigelman
authors.affiliation: Department of Internal Medicine A, Bnai Zion Medical Center, PO Box 4940, 31048, Haifa, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Dawood
authors.affiliation: Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Rimar
authors.affiliation: Department of Radiology, Bnai Zion Medical Center, Haifa, Israel.
authors.forename: Simona
authors.initials: S
authors.lastname: Croitoru
authors.affiliation: Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Boulman
authors.affiliation: Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Rozenbaum
authors.affiliation: Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kaly
authors.affiliation: Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Rosner
authors.affiliation: Department of Internal Medicine A, Bnai Zion Medical Center, PO Box 4940, 31048, Haifa, Israel.|Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: Majed
authors.initials: M
authors.lastname: Odeh
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: Ankylosing spondylitis; Computed tomography; Craniocervical junction; Spine