Cervicomedullary compression: An unrecognized cause of vocal cord paralysis in rheumatoid arthritis

Dana Thompson Link, Thomas V. McCaffrey, Michael J. Link, William E. Krauss, M. Troy Ferguson

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto- axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral- transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.

Original languageEnglish (US)
Pages (from-to)462-471
Number of pages10
JournalAnnals of Otology, Rhinology and Laryngology
Volume107
Issue number6
StatePublished - 1998

Fingerprint

Vocal Cord Paralysis
Rheumatoid Arthritis
Vocal Cords
Atlanto-Axial Joint
Decompression
Brain Stem
Arthritis
Neck Pain
Spinal Cord Diseases
Skull Base
Paresis
Airway Obstruction
Paralysis
Joints
Physicians

Keywords

  • Basilar invagination
  • Cervicomedullary compression
  • Occipito-atlanto- axial joint subluxation
  • Odontoid process
  • Pannus formation
  • Rheumatoid arthritis
  • Vocal cord paralysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Link, D. T., McCaffrey, T. V., Link, M. J., Krauss, W. E., & Troy Ferguson, M. (1998). Cervicomedullary compression: An unrecognized cause of vocal cord paralysis in rheumatoid arthritis. Annals of Otology, Rhinology and Laryngology, 107(6), 462-471.

Cervicomedullary compression : An unrecognized cause of vocal cord paralysis in rheumatoid arthritis. / Link, Dana Thompson; McCaffrey, Thomas V.; Link, Michael J.; Krauss, William E.; Troy Ferguson, M.

In: Annals of Otology, Rhinology and Laryngology, Vol. 107, No. 6, 1998, p. 462-471.

Research output: Contribution to journalArticle

Link, DT, McCaffrey, TV, Link, MJ, Krauss, WE & Troy Ferguson, M 1998, 'Cervicomedullary compression: An unrecognized cause of vocal cord paralysis in rheumatoid arthritis', Annals of Otology, Rhinology and Laryngology, vol. 107, no. 6, pp. 462-471.
Link, Dana Thompson ; McCaffrey, Thomas V. ; Link, Michael J. ; Krauss, William E. ; Troy Ferguson, M. / Cervicomedullary compression : An unrecognized cause of vocal cord paralysis in rheumatoid arthritis. In: Annals of Otology, Rhinology and Laryngology. 1998 ; Vol. 107, No. 6. pp. 462-471.
@article{be3a42fe4c174015ac4c767dfe798b3c,
title = "Cervicomedullary compression: An unrecognized cause of vocal cord paralysis in rheumatoid arthritis",
abstract = "Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto- axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral- transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.",
keywords = "Basilar invagination, Cervicomedullary compression, Occipito-atlanto- axial joint subluxation, Odontoid process, Pannus formation, Rheumatoid arthritis, Vocal cord paralysis",
author = "Link, {Dana Thompson} and McCaffrey, {Thomas V.} and Link, {Michael J.} and Krauss, {William E.} and {Troy Ferguson}, M.",
year = "1998",
language = "English (US)",
volume = "107",
pages = "462--471",
journal = "Annals of Otology, Rhinology and Laryngology",
issn = "0003-4894",
publisher = "Annals Publishing Company",
number = "6",

}

TY - JOUR

T1 - Cervicomedullary compression

T2 - An unrecognized cause of vocal cord paralysis in rheumatoid arthritis

AU - Link, Dana Thompson

AU - McCaffrey, Thomas V.

AU - Link, Michael J.

AU - Krauss, William E.

AU - Troy Ferguson, M.

PY - 1998

Y1 - 1998

N2 - Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto- axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral- transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.

AB - Cervicomedullary compression (CMC) from traumatic, infectious, or congenital processes of the atlanto-axial joint is a known cause of vocal cord immobility. Cervicomedullary compression can also occur from destructive arthritic changes and inflammatory pannus formation at the occipito-atlanto- axial joint in patients with rheumatoid arthritis (RA). We present findings suggesting that CMC in patients with RA is an unrecognized cause of vocal cord immobility. Previously, vocal cord immobility in patients with RA has been assumed to be cricoarytenoid arthritis with joint fixation. We report 3 patients with RA and radiographically demonstrated CMC with vocal cord immobility. One patient had bilateral vocal cord immobility and airway obstruction; 2 patients had unilateral cord paralysis and contralateral paresis without airway compromise. All patients had myelopathy and neck pain in addition to brain stem symptoms. All patients underwent transoral- transpharyngeal decompression of the anterior craniocervical junction with subsequent posterior fusion. These patients demonstrated full return of vocal cord function within 3 months of decompression. We propose that CMC is a cause of vocal cord paralysis in patients with RA that may go unrecognized without appropriate imaging studies of the skull base and physician awareness of symptoms of occipito-atlanto-axial subluxation and/or basilar invagination with brain stem compression. Our results demonstrate that CMC in RA is a potentially reversible cause of vocal cord paralysis.

KW - Basilar invagination

KW - Cervicomedullary compression

KW - Occipito-atlanto- axial joint subluxation

KW - Odontoid process

KW - Pannus formation

KW - Rheumatoid arthritis

KW - Vocal cord paralysis

UR - http://www.scopus.com/inward/record.url?scp=0031781048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031781048&partnerID=8YFLogxK

M3 - Article

C2 - 9635455

AN - SCOPUS:0031781048

VL - 107

SP - 462

EP - 471

JO - Annals of Otology, Rhinology and Laryngology

JF - Annals of Otology, Rhinology and Laryngology

SN - 0003-4894

IS - 6

ER -