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BioMed Research International
Volume 2017 (2017), Article ID 6131703, 7 pages
Research Article

Rheumatoid Arthritis Affecting the Upper Cervical Spine: Biomechanical Assessment of the Stabilizing Ligaments

1Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
2Center for Spinal Surgery, Schön Klinik Düsseldorf, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
3Medical Department, Luzerner Kantonsspital, Spitalstrasse 16, 6000 Luzern, Switzerland
4Department of Orthopedics and Trauma Surgery, HELIOS Klinikum Siegburg, Ringstraße 49, 53721 Siegburg, Germany

Correspondence should be addressed to Carolin Meyer; ed.nleok-ku@reyem.nilorac

Received 29 April 2017; Revised 29 August 2017; Accepted 13 September 2017; Published 18 October 2017

Academic Editor: Harry W. Schroeder

Copyright © 2017 Carolin Meyer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Diameters of anterior and posterior atlantodental intervals (AADI and PADI) are diagnostically conclusive regarding ongoing neurological disorders in rheumatoid arthritis. MRI and X-ray are mostly used for patients’ follow-up. This investigation aimed at analyzing these intervals during motion of cervical spine, when transverse and alar ligaments are damaged. AADI and PADI of 10 native, human cervical spines were measured using lateral fluoroscopy, while the spines were assessed in neutral position first, in maximal inclination second, and in maximal extension at last. First, specimens were evaluated under intact conditions, followed by analysis after transverse and alar ligaments were destroyed. Damage of the transverse ligament leads to an increase of the AADI’s diameter about 0.65 mm in flexion and damage of alar ligaments results in significant enhancement of 3.59 mm at mean. In extension, the AADI rises 0.60 mm after the transverse ligament was cut and 0.90 mm when the alar ligaments are damaged. After all ligaments are destroyed, AADI assessed in extension closely resembles AADI at neutral position. Ligamentous damage showed an average significant decrease of the PADI of 1.37 mm in the first step and of 3.57 mm in the second step in flexion, while it is reduced about 1.61 mm and 0.41 mm in the extended and similarly in the neutrally positioned spine. Alar and transverse ligaments are both of obvious importance in order to prevent AAS and movement-related spinal cord compression. Functional imaging is necessary at follow-up in order to identify patients having an advanced risk of neurological disorders.