Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy

Objective. To identify the features of rheumatoid cervical spine disease as sociated with deterioration resulting in the need for surgical intervention or death. Patients and methods. Patients With rheumatoid cervical myelopathy who unde rwent cervical spine magnetic resonance imaging (MRI) between 1991 and 1996 were identified. Patients requiring immediate surgical intervention were e xcluded. The remainder were divided into two groups. Deterioration group: p atients requiring surgical intervention during the follow-up period and dea ths resulting from cervical myelopathy. Conservative group: all other patie nts. Relevant clinical features and radiology reports were extracted retros pectively from the casesheet. Results. The deterioration group comprised 11 patients (12%), median time t o deterioration 15 months (range 4-84 months). The conservative group inclu ded 82 patients. Initial clinical features did not differ significantly bet ween the two groups. Sixty per cent of those patients with compression or i mpingement at the atlanto-axial level on first MRI deteriorated over a medi an of 12 months (range 4-36 months). Conclusion. Deterioration is likely if there is evidence of cord compromise at the atlanto-axial level on MRI regardless of initial clinical and plain X-ray features.