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Canadian Journal of Anesthesia, Vol 40, 154-159, Copyright © 1993 by Canadian Anesthesiologists' Society

ARTICLES

Rheumatoid cervical joint disease--a challenge to the anaesthetist

A Macarthur and S Kleiman
Department of Anaesthesia, SMBD-Jewish General Hospital, Montreal, Quebec.

Cervical joint disease in rheumatoid arthritis patients is common. These patients may be at risk for severe life-threatening neurological problems in the perioperative period and thus present a challenge to the anaesthetist. By understanding the various anatomical abnormalities that may occur in rheumatoid cervical joint disease, the anaesthetist can design an appropriate management plan for the patient. The destruction of normal anatomy by rheumatoid arthritis can result in atlanto-axial subluxation (AAS) or subaxial subluxation. The atlanto-axial subluxation is further divided anatomically into anterior AAS, posterior AAS, vertical AAS, and lateral/rotatory AAS. In addition to the history and physical examination of the rheumatoid arthritis patient, radiological evaluation of the cervical spine is highly recommended. With the identification of the specific anatomical lesion the anaesthetist can predict and avoid movements which may lead to, or worsen, neurological problems. In the event of an emergency where full evaluation of the cervical spine is not possible the anaesthetist must presume that the rheumatoid patient has severe cervical spine instability and use the most cautious approach.




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Copyright © 1993 by the Canadian Anesthesiologists' Society.