Natural history of rheumatoid cervical luxations.

Luxation of the cervical spine, if looked for, is commonly observed at some stage during the longterm care of patients with rheumatoid arthritis. At the atlanto-axial level up to a quarter of patients admitted to hospital with rheumatoid arthritis can be expected to have luxations and about half will have subaxial luxations at two or more levels (Sharp and Purser, 1961; Conlon, Isdale, and Rose, 1966; Sharp, 1964). Pain and stiffness in the neck may be present but are frequently absent and often the luxations cause no symptoms or disability. Occasionally the presenting symptoms are transient blackouts, tetraplegia, sudden death, or other neurological complications resulting from damage to the cervical cord or interference with the flow of the vertebral arteries (Ball and Sharp, 1971). In this paper we report the results of a study of the natural history of cervical luxation in patients with rheumatoid arthritis, with particular reference to the development of dangerous neurological complications.