Letters to the Editor   |    
Magnetic Resonance Imaging of the Rheumatic Cervical Spine
Kari Laiho, MD, PhD; Irma Soini, MD, PhD; Markku Kauppi, MD, PhD
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The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Dec 01;85(12):2482-2483
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To The Editor:We read with great interest the article "Magnetic Resonance Imaging of the Cervical Spine. Current Techniques and Spectrum of Disease" (2002;84[Suppl 2]:S70-S80), by Khanna et al. As unstable anterior atlantoaxial subluxation is often detected in patients with rheumatoid arthritis and is usually evaluated with magnetic resonance imaging before operative treatment, we would like to raise an important point concerning that matter. In our study of twenty-three patients with rheumatoid arthritis, functional magnetic resonance imaging often failed to detect the extent of even severely unstable anterior atlantoaxial subluxation (>9 mm) noted on functional radiography1. The main reason for this is probably the patient's supine position during the magnetic resonance imaging procedure, which may make it difficult to attain an adequate degree of neck flexion to elicit the full extent of the damage. With radiography, neck flexion is more easily attained because the patient is sitting during the examination and gravity pulls the head and atlas apart from the axis (i.e., creates anterior atlantoaxial subluxation) if the ligaments are injured. One should thus not rely on magnetic resonance imaging alone; functional radiographs should also be made to evaluate the magnitude of unstable anterior atlantoaxial subluxation in patients with rheumatoid arthritis.
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