||METHODS. Eleven patients with paralysis, secondary
to rheumatoid arthritis of the cervical spine were analyzed postmortem.
Neurologic classification (Ranawat) included one Class 2, four Class IIIA,
and six Class IIIB. Rheumatologic changes included atlantoaxial subluxation,
basilar invagination, and subaxial subluxation. During autopsy the entire
cervical spine was removed, including the occiput and foramen magnum. The
spinal cord and medulla oblongata were removed en toto and examined histologically
by a neuropathologist. RESULTS. Nine of the eleven cases revealed abnormal
histology of the spinal cord, and in two patients, the spinal cords were
normal. Three histologic types of spinal cord compression were identified.
In Type 1 (four cases) severe chronic mechanical compression revealed marked
mechanical distortion, flattening, and destruction of the cord with secondary
Wallerian degeneration of the ascending and descending tracts without anoxicischemic
neuron changes. In Type 2 (three cases), there was vascular compression
showing ischemic damage to the cord with necrosis of the lateral columns
in the ischemic watershed regions supplied by anterior and posterior spinal
arteries. In Type 3 (two cases), there was mild mechanical compression showing
focal gliosis at the site of compression without ascending or descending
tract injury. Two of the eleven cases had thrombosis of the vertebral arteries.
Of the eleven cases analyzed, two had normal spinal cords. CONCLUSION. This
autopsy analysis of rheumatoid cervical spine suggests that paralysis can
be due to both mechanical neural compression and/or vascular impairment.