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Atlanto-axial impaction and compression of the medulla oblongata and proximal spinal cord in rheumatoid arthritis evaluated by CT scanning.

The radiological features of atlanto-axial impaction (AAI) and subluxation of C1-C2 in rheumatoid arthritis are well documented in the literature (Castor et al, 1983; Halla & Fallahi, 1981; Weiner et al, 1982; Weissman et al, 1982). In the past conventional radiography and air or positive myelography were necessary to demonstrate compression of the spinal cord or medulla and its relationship to subluxation, the position of the odontoid or the mass of a granuloma. With the advent of CT scanning the same information can be generated in a multiplanar form (Vancoillie et al, 1981) using CT metrizamide myelography (CTMM). A 66-year-old man presented with severe paresis of the upper limbs with amyotrophy of the hands and impaired gait, but with no sensory loss. He had a long-established history of severe rheumatoid arthritis, cervicobrachialgia, diffuse swelling of knees and feet and joint pains. The patient was referred for conventional radiographs of the cervical spine including tomography, myelography and se...