A clinico-pathological study of cervical myelopathy in rheumatoid arthritis: post-mortem analysis of two cases

Two patients who developed cervical myelopathy secondary to rheumatoid arth ritis were analyzed post mortem. One patient had anterior atlanto-axial sub luxation (AAS) combined with subaxial subluxation (SS), and the other had v ertical subluxation (VS) combined with SS. In the patient with AAS, the pos terior aspect of the spinal cord demonstrated severe constriction at the C2 segment, which arose from dynamic osseous compression by the Cl posterior arch. A histological cross-section of the spinal cord at the segment was ch aracterized by distinct necrosis in the posterior white columns and the gra y matter. In the patient with VS, the upper cervical cord and medulla oblon gata showed angulation over the invaginated odontoid process, whereas no si gnificant pathological changes were observed. At the level of SS, the spina l cord was pinched and compressed between the upper corner of the vertebral body and the lower edge of the lamina. Histologically, demyelination and g liosis were observed in the posterior and lateral white columns.