Portal de Periódicos da CAPES

Pathologic Fracture of the Odontoid Process in the Rheumatoid Arthritis

1968; Radiological Society of North America; Volume: 90; Issue: 5 Linguagem: Inglês

10.1148/90.5.948

1527-1315

William Martel, Giles G. Bole,

Infectious Diseases and Tuberculosis

It is now well recognized that the cervical spine is commonly affected in rheumatoid disease and that subluxation of the atlas is frequently present (1–4) and may occasionally be fatal (5). It is not widely appreciated, however, that some rheumatoid patients may develop fractures of the odontoid process in association with relatively minimal trauma or no trauma at all. This report concerns 3 such patients who have recently come to our attention. Case Reports Case I:2 Polyarthritis first developed in this 53-year-old white female in 1939 at twenty-eight years of age. She was seen at the University of Michigan Medical Center in 1943 and was considered to have classic rheumatoid arthritis, for which she was followed until 1964, requiring numerous hospitalizations during this period. She had progressive, severe involvement of the peripheral joints and chronic, recurrent ulcers of the legs and ankles. Multiple subcutaneous nodules over the extensor surfaces of the extremities were observed, and the latex test for the rheumatoid factor was positive (1:1280). Cortisone was administered orally from 1950 to 1951 and again for a brief period in 1952. She had received several courses of gold therapy early in her disease and was maintained on monthly injections from 1955 until 1964, when she was last seen. The patient first complained in 1961 of slowly progressing cervical stiffness of three years duration, but there were no neurologic symptoms. Cervical roentgenograms at that time showed superficial erosions of the apophyseal joints and of the tip of the spinous process of C7. There was an anterior subluxation of the atlas in flexion of approximately 7 mm. These changes in the cervical spine were consistent with rheumatoid arthritis. Laminagrams were not obtained. In 1962 this patient was included in a radiologic study of randomly selected patients with rheumatoid arthritis. Cervical laminagrams and roentgenograms of the entire spine which were obtained as part of that study showed an oblique fracture through the base of the odontoid process (Fig. 1, A) and a 4-mm separation of the anterior arch of the atlas and the odontoid process in flexion (Fig. 1, B). The fracture margins appeared somewhat irregular, suggesting that the fracture had developed through an eroded area. The bones were only slightly osteoporotic. The patient denied a history of trauma, and there had been no change in her cervical symptoms. Neurologic examination in March 1964 showed Grade 1 rotatory nystagmus on lateral conjugate gaze and blunting of pain perception in the lower extremities up to the midcalf. Symmetrical atrophy of the muscles of the extremities and absence of the deep tendon reflexes of the knees and ankles were noted. There were no pathologic reflexes.