{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T07:13:38Z","timestamp":1788592418156,"version":"build-2803163510"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>Cervical spine involvement commonly occurs in patients with rheumatoid arthritis (RA), especially those with inadequate treatment or severe disease forms. The most common site affected by RA is the atlantoaxial joint, potentially resulting in atlantoaxial instability, with cervical pain and neurological deficits. The second most common site of involvement is the subaxial cervical spine, often with subluxation, resulting in nerve root or spinal cord compression.<\/jats:p>\n                  <jats:p>In this paper, the authors review the most commonly used plain radiographic criteria to diagnose cervical instabilities seen with RA. Finally, we discuss the advantages and disadvantages of cervical CT and MRI in the setting of cervical involvement in RA.<\/jats:p>","DOI":"10.3171\/2015.1.focus14664","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E4","source":"Crossref","is-referenced-by-count":90,"title":["Radiological evaluation of cervical spine involvement in rheumatoid arthritis"],"prefix":"10.3171","volume":"38","author":[{"given":"Andrei F.","family":"Joaquim","sequence":"first","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ghizoni","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helder","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Appenzeller","sequence":"additional","affiliation":[{"name":"Medicine and Rheumatology, State University of Campinas (UNICAMP), Campinas, S\u00e3o Paulo, Brazil; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Daniel","family":"Riew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"MD","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine and Barnes Jewish Hospital, Saint Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14664","series-title":"J Assoc Physicians India","first-page":"468","article-title":"Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with overall disease severity","volume":"44","author":"Aggarwal","year":"1996"},{"key":"b2-focus14664","series-title":"Rheumatol Int","first-page":"1363","article-title":"Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis","volume":"31","author":"Ahn","year":"2011"},{"key":"b3-focus14664","series-title":"Acta Radiol","first-page":"543","article-title":"Functional MR imaging of the cervical spine in patients with rheumatoid arthritis","volume":"39","author":"Allmann","year":"1998"},{"key":"b4-focus14664","series-title":"Scand J Rheumatol","first-page":"281","article-title":"Long-term follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis","volume":"42","author":"Blom","year":"2013"},{"key":"b5-focus14664","series-title":"J Bone Joint Surg Am","first-page":"1282","article-title":"Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery","volume":"75","author":"Boden","year":"1993"},{"key":"b6-focus14664","series-title":"Ann Rheum Dis","first-page":"341","article-title":"Lateral subluxation of the atlas in rheumatoid arthritis: a case report and post-mortem study","volume":"43","author":"Bogduk","year":"1984"},{"key":"b7-focus14664","series-title":"AJR Am J Roentgenol","first-page":"181","article-title":"Rheumatoid arthritis of the cervical spine: surface-coil MR imaging","volume":"151","author":"Bundschuh","year":"1988"},{"key":"b8-focus14664","series-title":"Yale J Biol Med","first-page":"487","article-title":"Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations","volume":"11","author":"Chamberlain","year":"1939"},{"key":"b9-focus14664","series-title":"J Bone Joint Surg Am","first-page":"381","article-title":"Arthrodesis of the cervical spine in rheumatoid arthritis","volume":"71","author":"Clark","year":"1989"},{"key":"b10-focus14664","series-title":"Eur Radiol","first-page":"1416","article-title":"Rheumatoid arthritis of the craniocervical region: assessment and characterization of inflammatory soft tissue proliferations with unenhanced and contrast-enhanced CT","volume":"10","author":"Czerny","year":"2000"},{"key":"b11-focus14664","series-title":"Rev Rhum Mal Osteoartic","first-page":"261","article-title":"Radio-tomography of the impression fractures of the cranial basis","volume":"19","author":"Fischgold","year":"1952"},{"key":"b12-focus14664","series-title":"Rheum Dis Clin North Am","first-page":"317","article-title":"The surgical management of patients with rheumatoid cervical spine disease","volume":"23","author":"Gurley","year":"1997"},{"key":"b13-focus14664","series-title":"Ann Rheum Dis","first-page":"434","article-title":"Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years","volume":"59","author":"Hamilton","year":"2000"},{"key":"b14-focus14664","series-title":"J Trauma","first-page":"902","article-title":"Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis","volume":"58","author":"Holmes","year":"2005"},{"key":"b15-focus14664","series-title":"Autoimmun Rev","first-page":"1195","article-title":"Cervical spine involvement in rheumatoid arthritis\u2014a systematic review","volume":"13","author":"Joaquim","year":"2014"},{"key":"b16-focus14664","series-title":"Arq Neuropsiquiatr","first-page":"857","article-title":"Axis instrumentation: surgical results","volume":"70","author":"Joaquim","year":"2012"},{"key":"b17-focus14664","series-title":"JAMA","first-page":"648","article-title":"Prospects for autoimmune disease: research advances in rheumatoid arthritis","volume":"285","author":"Koopman","year":"2001"},{"issue":"3 Suppl","key":"b18-focus14664","series-title":"Neurosurgery","first-page":"83","article-title":"Rheumatoid arthritis of the craniovertebral junction","volume":"66","author":"Krauss","year":"2010"},{"key":"b19-focus14664","series-title":"Radiology","first-page":"57","article-title":"Rheumatoid arthritis: epidural enhancement as an underestimated cause of subaxial cervical spinal stenosis","volume":"231","author":"Kroft","year":"2004"},{"key":"b20-focus14664","series-title":"Clin Neurol Neurosurg","first-page":"111","article-title":"Pannus regression after posterior decompression and occipi-to-cervical fixation in occipito-atlanto-axial instability due to rheumatoid arthritis: case report and literature review","volume":"115","author":"Landi","year":"2013"},{"key":"b21-focus14664","series-title":"Radiol Med","first-page":"1111","article-title":"MR imaging of atlantoaxial joint in early rheumatoid arthritis","volume":"115","author":"Magarelli","year":"2010"},{"key":"b22-focus14664","series-title":"Arthritis Rheum","first-page":"1775","article-title":"Cervical spine disease in rheumatoid arthritis: how common a finding? How uncommon a problem?","volume":"48","author":"Matteson","year":"2003"},{"key":"b23-focus14664","series-title":"Br J Radiol","first-page":"171","article-title":"The significance of certain measurements of the skull in the diagnosis of basilar impression","volume":"21","author":"McGregor","year":"1948"},{"key":"b24-focus14664","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"23","article-title":"Occipitalization of the atlas","volume":"70","author":"McRae","year":"1953"},{"key":"b25-focus14664","series-title":"Spine J","first-page":"1477","article-title":"Outcome of surgery for rheumatoid cervical spine at one institute over three decades","volume":"13","author":"Miyamoto","year":"2013"},{"key":"b26-focus14664","series-title":"Rheumatology (Oxford)","first-page":"1814","article-title":"Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings","volume":"47","author":"Narv\u00e1ez","year":"2008"},{"key":"b27-focus14664","series-title":"Ann Rheum Dis","first-page":"884","article-title":"High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery","volume":"65","author":"Neva","year":"2006"},{"key":"b28-focus14664","series-title":"Spine J","first-page":"329","article-title":"Rheumatoid arthritis of the cervical spine","volume":"4","author":"Nguyen","year":"2004"},{"key":"b29-focus14664","series-title":"J Bone Joint Surg Am","first-page":"1003","article-title":"Cervical spine fusion in rheumatoid arthritis","volume":"61","author":"Ranawat","year":"1979"},{"key":"b30-focus14664","series-title":"Acta Radiol Diagn (Stockh)","first-page":"23","article-title":"Radiographic measurements of the cranio-vertebral region. 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The reliability of radiographic criteria","volume":"83-A","author":"Riew","year":"2001"},{"key":"b33-focus14664","series-title":"Spine J","first-page":"689","article-title":"Rheumatoid arthritis: evaluation and surgical management of the cervical spine","volume":"4","author":"Shen","year":"2004"},{"key":"b34-focus14664","series-title":"AJR Am J Roentgenol","first-page":"585","article-title":"Rheumatoid arthritis of the craniocervical region by MR imaging: detection and characterization","volume":"165","author":"Stiskal","year":"1995"},{"key":"b35-focus14664","series-title":"BMC Musculoskelet Disord","first-page":"203","article-title":"Clinical characteristics of rheumatoid arthritis patients undergoing cervical spine surgery: an analysis of National Database of Rheumatic Diseases in Japan","volume":"15","author":"Sugita","year":"2014"},{"key":"b36-focus14664","series-title":"Semin Musculoskelet Radiol","first-page":"79","article-title":"Magnetic resonance imaging in early detection of rheumatoid arthritis","volume":"7","author":"Tehranzadeh","year":"2003"},{"key":"b37-focus14664","series-title":"Roentgen Diagnosis of the Craniovertebral Region","author":"Wackenheim","year":"1974"},{"key":"b38-focus14664","series-title":"Bull NYU Hosp Jt Dis","first-page":"136","article-title":"Rheumatoid arthritis of the cervical spine\u2014clinical considerations","volume":"69","author":"Wasserman","year":"2011"},{"issue":"109","key":"b39-focus14664","series-title":"Clin Orthop Relat Res","first-page":"85","article-title":"Biomechanical analysis of clinical stability in the cervical spine","author":"White","year":"1975"},{"key":"b40-focus14664","series-title":"Zhonghua Yi Xue Za Zhi","first-page":"901","article-title":"Clinical characteristics and diagnosis of rheumatoid arthritis of upper cervical spine: analysis of 71 cases","volume":"88","author":"Yan","year":"2008"},{"key":"b41-focus14664","series-title":"Spine (Phila Pa 1976)","first-page":"208","article-title":"Subaxial lesions in rheumatoid arthritis. Radiographic factors suggestive of lower cervical myelopathy","volume":"20","author":"Yonezawa","year":"1995"},{"key":"b42-focus14664","series-title":"Joint Bone Spine","first-page":"361","article-title":"Compared imaging of the rheumatoid cervical spine: prevalence study and associated factors","volume":"76","author":"Younes","year":"2009"},{"key":"b43-focus14664","series-title":"Spine (Phila Pa 1976)","first-page":"2136","article-title":"Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis: a prospective minimum 5-year follow-up study of patients initially without cervical involvement","volume":"37","author":"Yurube","year":"2012"},{"key":"b44-focus14664","series-title":"J Rheumatol","first-page":"801","article-title":"Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study","volume":"32","author":"Zikou","year":"2005"},{"key":"b45-focus14664","series-title":"J Rheumatol","first-page":"1178","article-title":"Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study","volume":"27","author":"Zoli","year":"2000"},{"key":"b1-focus14664","series-title":"J Assoc Physicians India","first-page":"468","article-title":"Cervical spine involvement in rheumatoid arthritis: prevalence and relationship with overall disease severity","volume":"44","author":"Aggarwal","year":"1996"},{"key":"b2-focus14664","series-title":"Rheumatol Int","first-page":"1363","article-title":"Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis","volume":"31","author":"Ahn","year":"2011"},{"key":"b3-focus14664","series-title":"Acta Radiol","first-page":"543","article-title":"Functional MR imaging of the cervical spine in patients with rheumatoid arthritis","volume":"39","author":"Allmann","year":"1998"},{"key":"b4-focus14664","series-title":"Scand J Rheumatol","first-page":"281","article-title":"Long-term follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis","volume":"42","author":"Blom","year":"2013"},{"key":"b5-focus14664","series-title":"J Bone Joint Surg Am","first-page":"1282","article-title":"Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery","volume":"75","author":"Boden","year":"1993"},{"key":"b6-focus14664","series-title":"Ann Rheum Dis","first-page":"341","article-title":"Lateral subluxation of the atlas in rheumatoid arthritis: a case report and post-mortem study","volume":"43","author":"Bogduk","year":"1984"},{"key":"b7-focus14664","series-title":"AJR Am J Roentgenol","first-page":"181","article-title":"Rheumatoid arthritis of the cervical spine: surface-coil MR imaging","volume":"151","author":"Bundschuh","year":"1988"},{"key":"b8-focus14664","series-title":"Yale J Biol Med","first-page":"487","article-title":"Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations","volume":"11","author":"Chamberlain","year":"1939"},{"key":"b9-focus14664","series-title":"J Bone Joint Surg Am","first-page":"381","article-title":"Arthrodesis of the cervical spine in rheumatoid arthritis","volume":"71","author":"Clark","year":"1989"},{"key":"b10-focus14664","series-title":"Eur Radiol","first-page":"1416","article-title":"Rheumatoid arthritis of the craniocervical region: assessment and characterization of inflammatory soft tissue proliferations with unenhanced and contrast-enhanced CT","volume":"10","author":"Czerny","year":"2000"},{"key":"b11-focus14664","series-title":"Rev Rhum Mal Osteoartic","first-page":"261","article-title":"Radio-tomography of the impression fractures of the cranial basis","volume":"19","author":"Fischgold","year":"1952"},{"key":"b12-focus14664","series-title":"Rheum Dis Clin North Am","first-page":"317","article-title":"The surgical management of patients with rheumatoid cervical spine disease","volume":"23","author":"Gurley","year":"1997"},{"key":"b13-focus14664","series-title":"Ann Rheum Dis","first-page":"434","article-title":"Improved medical and surgical management of cervical spine disease in patients with rheumatoid arthritis over 10 years","volume":"59","author":"Hamilton","year":"2000"},{"key":"b14-focus14664","series-title":"J Trauma","first-page":"902","article-title":"Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis","volume":"58","author":"Holmes","year":"2005"},{"key":"b15-focus14664","series-title":"Autoimmun Rev","first-page":"1195","article-title":"Cervical spine involvement in rheumatoid arthritis\u2014a systematic review","volume":"13","author":"Joaquim","year":"2014"},{"key":"b16-focus14664","series-title":"Arq Neuropsiquiatr","first-page":"857","article-title":"Axis instrumentation: surgical results","volume":"70","author":"Joaquim","year":"2012"},{"key":"b17-focus14664","series-title":"JAMA","first-page":"648","article-title":"Prospects for autoimmune disease: research advances in rheumatoid arthritis","volume":"285","author":"Koopman","year":"2001"},{"issue":"3 Suppl","key":"b18-focus14664","series-title":"Neurosurgery","first-page":"83","article-title":"Rheumatoid arthritis of the craniovertebral junction","volume":"66","author":"Krauss","year":"2010"},{"key":"b19-focus14664","series-title":"Radiology","first-page":"57","article-title":"Rheumatoid arthritis: epidural enhancement as an underestimated cause of subaxial cervical spinal stenosis","volume":"231","author":"Kroft","year":"2004"},{"key":"b20-focus14664","series-title":"Clin Neurol Neurosurg","first-page":"111","article-title":"Pannus regression after posterior decompression and occipi-to-cervical fixation in occipito-atlanto-axial instability due to rheumatoid arthritis: case report and literature review","volume":"115","author":"Landi","year":"2013"},{"key":"b21-focus14664","series-title":"Radiol Med","first-page":"1111","article-title":"MR imaging of atlantoaxial joint in early rheumatoid arthritis","volume":"115","author":"Magarelli","year":"2010"},{"key":"b22-focus14664","series-title":"Arthritis Rheum","first-page":"1775","article-title":"Cervical spine disease in rheumatoid arthritis: how common a finding? How uncommon a problem?","volume":"48","author":"Matteson","year":"2003"},{"key":"b23-focus14664","series-title":"Br J Radiol","first-page":"171","article-title":"The significance of certain measurements of the skull in the diagnosis of basilar impression","volume":"21","author":"McGregor","year":"1948"},{"key":"b24-focus14664","series-title":"Am J Roentgenol Radium Ther Nucl Med","first-page":"23","article-title":"Occipitalization of the atlas","volume":"70","author":"McRae","year":"1953"},{"key":"b25-focus14664","series-title":"Spine J","first-page":"1477","article-title":"Outcome of surgery for rheumatoid cervical spine at one institute over three decades","volume":"13","author":"Miyamoto","year":"2013"},{"key":"b26-focus14664","series-title":"Rheumatology (Oxford)","first-page":"1814","article-title":"Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings","volume":"47","author":"Narv\u00e1ez","year":"2008"},{"key":"b27-focus14664","series-title":"Ann Rheum Dis","first-page":"884","article-title":"High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery","volume":"65","author":"Neva","year":"2006"},{"key":"b28-focus14664","series-title":"Spine J","first-page":"329","article-title":"Rheumatoid arthritis of the cervical spine","volume":"4","author":"Nguyen","year":"2004"},{"key":"b29-focus14664","series-title":"J Bone Joint Surg Am","first-page":"1003","article-title":"Cervical spine fusion in rheumatoid arthritis","volume":"61","author":"Ranawat","year":"1979"},{"key":"b30-focus14664","series-title":"Acta Radiol Diagn (Stockh)","first-page":"23","article-title":"Radiographic measurements of the cranio-vertebral region. 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