| Eric A. Brandser, M.D.
Peer Review Status: Internally Peer Reviewed
The vertebral bodies appear white due to
the large amount of fat located in the marrow. Notice that
the gap between C1 and C2 is too wide. There is a synovial
joint that sits between the odontoid process and anterior
arch of C1 which can be affected by RA. As the pannus erodes
the bone, it will also degenerate the alar check ligaments
which stablize C1. If the ligaments are weakened then C1 can
impinge upon the spinal cord (arrow). Injury to the cord occasionally
occurs in surgery when the head is tilted back to insert the
endotracheal tube. This is why anesthesia will occasionally
have orthopedics check for C1-C2 laxity in surgical patients
with RA. The patient is asked to flex and extend their neck
and if they display a large degree of motion , then a CT scan
is generated to check the vertebrae.
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