Nonreducible Rotational Head Tilt and Atlantoaxial Lateral Mass Collapse: Clinical and Roentgenographic Features in Patients With Juvenile Rheumatoid Arthritis and Ankylosing Spondylitis

doi:10.1001/archinte.1983.00350030085015

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Vol. 143 No. 3, March 1983

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Nonreducible Rotational Head Tilt and Atlantoaxial Lateral Mass Collapse

Clinical and Roentgenographic Features in Patients With Juvenile Rheumatoid Arthritis and Ankylosing Spondylitis

James T. Halla, MD; Sohrab Fallahi, MD; Joe G. Hardin, MD

Arch Intern Med. 1983;143(3):471-474.

Abstract

• Nonreducible rotational head tilt resulting from predominantlyunilateral collapse of the lateral mass of the atlas (C1) and/oraxis (C2) has been characterized in patients with rheumatoidarthritis. An identical phenomenon is reported in five patientswith juvenile rheumatoid arthritis (JRA) and in six with ankylosingspondylitis (AS). Most patients had neck pain and crepitus,all had a fixed head tilt deformity, and most also had a rotationaldeformity. Roentgenographically, all had predominantly unilateralcollapse of the lateral masses of C1 and/ or C2, and the headalways tilted toward the most collapsed side. The patients withJRA had polyarticular disease of long duration and generallymild neck symptoms, with only one requiring neck surgery forpain. The patients with AS tended to have proximal peripheraljoint involvement and long-standing disease with more severeneck symptoms; four underwent posterior cervical fusion forintractable pain. None of the 11 patients had demonstrable neurologicdeficits.

(Arch Intern Med 1983;143:471-474)

Author Affiliations

From the Division of Clinical Immunology and Rheumatology, the Department of Medicine, the University of Alabama in Birmingham (Drs Halla and Fallahi) and the Department of Medicine, University of Southern Alabama College of Medicine, Mobile (Dr Hardin). Dr Halla is now in private practice in Abilene, Tex.

Footnotes

Accepted for publication Nov 8, 1982.

Presented in part at the 45th annual meeting of the AmericanRheumatism Association, Boston, June 5, 1981.

Reprint requests to Department of Medicine, University of SouthernAlabama, 2451 Fillingim St, Mobile, AL 36617 (Dr Hardin).

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