Why is it important to evaluate patients with RA for cervical spine disease before surgery?
Although cervical spine disease in RA has decreased in frequency, instability of the cervical spine may still be present in patients with RA. In particular, cervical spine atlantoaxial subluxation can occur secondary to inflammation and weakening of the transverse ligament that holds the odontoid process of C2 against the anterior arch of C1. Manipulation of the neck during intubation and transport of the patient, especially extreme flexion or extension, can cause compression of the spinal cord by the odontoid process. Most anesthesiologists advocate for preoperative flexion and extension C-spine radiographs for RA patients with the following risk factors (C-SPINE), as significant cervical spine disease may be asymptomatic:
- —corticosteroid use
- —seropositive RA
- —peripheral joint destruction
- —involvement of cervical nerves (paresthesias, neck pain, weakness)
- —nodules (rheumatoid)
- —established disease (present >10 years)