CERVICOMEDULLARY COMPRESSION - AN UNRECOGNIZED CAUSE OF VOCAL CORD PARALYSIS IN RHEUMATOID-ARTHRITIS

Cervicomedullary compression (CMC) from traumatic, infectious, or cong enital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from dest ructive arthritic changes and inflammatory pannus formation at the occ ipito-atlanto-axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unre cognized cause of vocal cord immobility. Previously, vocal cord immobi lity in patients with RA has been assumed to be cricoarytenoid arthrit is with joint fixation. We report 3 patients with RA and radiographica lly demonstrated CMC with vocal cord immobility. One patient had bilat eral vocal cord immobility and airway obstruction; 2 patients had unil ateral cord paralysis and contralateral paresis without airway comprom ise. All patients had myelopathy and neck pain in addition to brain st em symptoms. All patients underwent transoral-transpharyngeal decompre ssion of the anterior craniocervical junction with subsequent posterio r fusion. These patients demonstrated full return of vocal cord functi on within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized wit hout appropriate imaging studies of the skull base and physician aware ness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.