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  • Title: Nystagmus and joint position sensation: their importance in posterior occipitocervical fusion in rheumatoid arthritis.
    Author: Rogers MA, Crockard HA, Moskovich R, Harkey HL, Stevens JM, Kendall BE, Ransford AO, Calder I, Corbett M, Shipley M.
    Journal: Spine (Phila Pa 1976); 1994 Jan 01; 19(1):16-20. PubMed ID: 8153798.
    Abstract:
    It is widely believed that brain stem dysfunction and cranial nerve palsies in patients with rheumatoid arthritis (RA) are common and related to the vertical translocation of the odontoid process. In our database of 235 patients with seropositive RA and craniocervical junction involvement, we have found a very low incidence of such problems. Long tract signs were common, but loss of proprioception (joint position sensation) as the sole neurologic deficit was rare. Nystagmus was found to be associated with the tonsillar herniation of a Chiari 1 malformation and loss of joint position sensation with severe compression of the posterior aspect of the spinal cord at the craniocervical junction. The implications for posterior occipitocervical fusion, particularly by sublaminar wiring, are discussed.
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