Cervical Deformity in Rheumatoid Arthritis

Rheumatoid arthritis leads to progressive synovial inflammation and joint destruction, with the cervical spine being the third most commonly affected area. Atlantoaxial instability is the most common presenting diagnosis, followed by subaxial instability and atlantoaxial impaction. Patients present with a range of symptoms from axial neck pain to frank myelopathy. Treatment begins with medical management in the early stages, which has shown promise in preventing or delaying atlantoaxial instability. Surgical treatment has shown good results but is reserved for patients with severe pain, instability, and progressive neurologic deficits and should adequately decompress the neural elements and fuse the unstable segments.