Assessment of the risk of occipitocervical dislocation in inflammatory rheumatic diseases

: In this mainly retrospective study we examined by means of tomographic and computer tomographic findings various manifestations and courses of cranio-cervical subluxations in chronic inflammatory rheumatic diseases and the resulting neurological complications. Even in marked cranio-cervical subluxations neurological complications are rarely observed. More serious anterior atlanto-axial subluxation represents the highest risk for spinal cord injury as a result of the mobility of the atlas. A subsequent vertical (upward) atlanto-axial subluxation occurring particularly in serious courses of illness reduces this risk since it is generally to be found together with a fixation of the atlas. This also applies to a possible pseudobasilar invagination. As a result of our studies we found ways of using CT to achieve further information. We could also derive guidelines for the indication of operative treatment. In view of the further development of surgical methods and variations in operative risk dependent on the preoperative situation, these recommendations can only be provisional.