Cervical Spondylosis due to Rheumatoid Arthritis with a Unique Clinical Course: A Case Report.

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Lesions of the rheumatoid cervical spine are mainly observed in the upper cervical spine. We experienced a case of rheumatoid cervical spondylosis assumed to be traceable to Luschka's joint of the lower cervical spine. The case was a 50 years-old female who had suffered from rheumatoid arthritis for 18 years. On 25th May, 1993, she developed numbness of her left hand. On 29th July, 1993, muscle weakness of her left lower extremity and urinary retention appeared. On admission, manual muscle testing revealed the bilateral upper extremities to be 0 to 1, right lower extremity 1 to 3, left lower extremity 5. Sensory disturbance was observed on bilateral upper extremities and left foot. Hyperreflexia of the deep tendon reflexes of the upper and lower extremities were observed. X-ray films showed narrowing of C4/5 disc space and anterior subluxation of C4. Myelography showed compression from the anterior and left side at C4/5. CT-myelography showed destructive change of bone and compression from antero-left side at C4/5. Postero-lateral fusion and anterior decompressive fusion were performed. During Surgery, bone destruction assumed to be traceable to rheumatoid granulation and posterior prominence of granulation tissue were observed. Post surgery, neurological symptoms remarkably improved.