POSTMORTEM OSSEOUS AND NEUROPATHOLOGIC ANALYSIS OF THE RHEUMATOID CERVICAL-SPINE

Methods. Eleven patients with paralysis, secondary to rheumatoid arthr itis of the cervical spine were analyzed postmortem. Neurologic classi fication (Ranawat) included one Class 2, four Class IIIA, and six Clas s IIIB. Rheumatologic changes included atlantoaxial subluxation, basil ar invagination, and subaxial subluxation. During autopsy the entire c ervical spine was removed, including the occiput and foramen magnum. T he spinal cord and medulla oblongata were removed en toto and examined histologically by a neuropathologist. Results. Nine of the eleven cas es revealed abnormal histology of the spinal cord, and in two patients , the spinal cords were normal. Three histologic types of spinal cord compression were identified. In Type 1 (four cases) severe chronic mec hanical compression revealed marked mechanical distortion, flattening, and destruction of the cord with secondary Wallerian degeneration of the ascending and descending tracts without anoxic-ischemic neuron cha nges. In Type 2 (three cases), there was vascular compression showing ischemic damage to the cord with necrosis of the lateral columns in th e ischemic watershed regions supplied by anterior and posterior spinal arteries. In Type 3 (two cases), there was mild mechanical compressio n showing focal gliosis at the site of compression without ascending o r descending tract injury. Two of the eleven cases had thrombosis of t he vertebral arteries. Of the eleven cases analyzed, two had normal sp inal cords. Conclusion. This autopsy analysis of rheumatoid cervical s pine suggests that paralysis can be due to both mechanical neural comp ression and/or vascular impairment.