Cervical gout.

STUDY DESIGN: A case report of a 60-year-old patient with rheumatoid arthritis who sustained injury of a tortuous vertebral artery after anterior cervical spinal fusion is reported. The literature relevant to this topic is reviewed. OBJECTIVE: To report the surgical injury of a tortuous vertebral artery resulting from rheumatoid arthritis and to stress the value of cross-sectional imaging in identifying this anomaly before surgery in these patients. BACKGROUND DATA: Rheumatoid arthritis causes well-known bony complications such as atlantoaxial and subaxial subluxation and spinal stenosis with spinal cord compression. Less emphasized is vertebral artery loop formation and vascular compression. Anomalous vertebral artery position could jeopardize otherwise successful anterior diskectomy and corpectomy in these patients. METHODS: A 60-year-old man with rheumatoid arthritis sustained a vertebral artery injury during anterior corpectomy, which resulted in cerebral and cerebellar infarction. RESULTS: Computed tomography and magnetic resonance imaging and angiography confirmed the medially deviated vertebral artery. A computed tomography scan confirmed the cerebral infarction that resulted from dissection and injury of the artery at the time of surgery. CONCLUSION: The patient with rheumatoid arthritis of the cervical spine could have associated tortuosity of the vertebral artery, mandating a thorough awareness of vascular anatomy before surgical decompression. Cross-sectional imaging effectively locates the position of the vertebral arteries and should be carefully studied before anterior cervical spinal fusion in these patients.

Cervical Vertebrae↗

PubMed2004

A new computer-aided technique for analysis of lateral cervical radiographs in postoperative patients with degenerative disease.

STUDY DESIGN: Radiographs were measured by four independent observers and remeasured by three of the observers. OBJECTIVES: To assess the reliability of a new computer-aided measurement technique. SUMMARY OF BACKGROUND DATA: Many studies have reported sagittal-plane distance and angle measurements in the cervical spine. Common measurement methods involve manual line drawing on lateral radiographs with manual or computer-aided distance and angle computation. In patients with anterior cervical fusion, changes in bony geometry could present difficulties for many existing methods. METHODS: Digitized lateral cervical radiographs are imported into a graphics software package. Outlines of the vertebral bodies and spinous processes are traced on the best-quality film and transformed to match the bony geometry on each remaining radiograph from the same patient. Intervertebral distance and angulation are calculated from centers of mass of the outlined elements. Segmental measurements were collected for 27 lateral radiographs from nine patients with anterior cervical discectomy and fusion. Intraclass and interclass correlation coefficients were calculated and used to compute standard errors of measurement. RESULTS: High intraclass and interclass correlations (ICCs) and low measurement errors were calculated for both distance and angle measurements. Intraexaminer mean ICCs were 0.92 for interbody distance and 0.93 for segmental angle, with standard errors of measurement (SEMs) of 3.26% interbody distance (approximately 0.65 mm) and 1.20 degrees sagittal-plane rotation. Mean interexaminer ICCs were 0.91 for interbody distance and 0.86 for segmental angle, with SEMs of 3.58% interbody distance (approximately 0.72 mm) and 1.77 degrees sagittal-plane rotation. CONCLUSIONS: The measurement method is reliable for both interbody distance and segmental angles within and among examiners. Whereas many existing measurement methods require normal radiographs to locate specific anatomic points, given intact spinous processes, the present method functions even with various radiographic abnormalities and in the presence of surgical decompression, degenerative disease, and cervical hardware. Because it does not rely on specific anatomic points, the present method is robust with respect to changes in the bony anatomy over time.

Cervical Vertebrae↗