“ 1. Atlantoaxial instability (C1 transverse ligament destruction by pannus). Frank instability in 5% with RA. Shown by pre-dentate space...
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1. Atlantoaxial instability (C1 transverse ligament destruction by pannus). Frank instability in 5% with RA. Shown by pre-dentate space >2.5 mm in adult.
2. Atlantoaxial impaction: severe atlantoaxial subluxation with collapse of the C1-2 facets and basilar invagination. Look for anterior slip of C1 so the anterior border of C1 lies anterior to the inferior border of C2.
3. Basilar invagination (tip of dens >5 mm above McGrigor’s line, drawn between superior border of the hard palate to the inferior border of the occiput).
4. Cord compression, especially in flexion. In the long term, the effect is myelomalacia. Associated with an increased risk of sudden death.
5. Loss of disc height.
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