Presentation
Neck pain for investigation.
Patient Data
Lateral views in flexion and extension have been obtained as requested. The tip of the dens cannot be clearly defined on the views obtained and there is a very slight widening of the space between the the dens and the anterior arch of C1, on flexion. Appearances raise the possibility of atlantoaxial subluxation and dens erosion.
Review of the previously obtained plain films has been undertaken. As shown on the plain films, there is slight widening of the atlanto-dens interval to just over 3 mm, and this is associated with an increased amount of soft tissue surrounding the anterior arch of the C1 vertebra, which demonstrates enhancement, and is associated with erosion of the dens, most notably anteriorly. A similar process involves the C1/2 lateral mass articulation with erosion and loss of height of the lateral mass of C1, which results in a degree of basilar invagination (tip of the dens is 8mm above Chamberlain's line), with no significant impingement upon the cervicomedullary junction.
At other levels, minor degenerative changes present, without significant canal stenosis and no significant neural foraminal stenosis.
Case Discussion
This patient has known rheumatoid arthritis.
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