Management of rheumatoid neck.

Rheumatoid arthritis of the neck is common but neurological complication occurs only in the minority. Nevertheless, this represents one of the few rheumatological emergencies. Surgery is the only definitive treatment, but diagnosis of this complication is often delayed so that candidates for surgery are frail and disabled, thus jeopardising the outcome. The advent of new forms of imaging, especially magnetic resonance imaging (MRI), when combined with careful clinical examination potentially offers a more efficient way of selecting patients for surgery. This is illustrated in the following case. fossa down to T4. TI weighted (fig IB) and T2 weighted MAST sagittal images were obtained together with TI weighted axial images (fig IC). This confirmed subluxation at the C6/7 level with severe restriction of the thecal sac. In addition there were subaxial subluxations at other levels, particularly obvious on the T2 weighted sagittal views. The axial views showed no evidence of myelomalacia. There was erosion of the odontoid peg but no significant subluxation at this level. The increased signal from the vertebral bodies on TI weighted images shown in Fig lB is due to fatty replacement of the marrow, which is typical of fused vertebrae.