Rheumatology

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Diagnostic validity of space available for the spinal cord at C1 level for cervical myelopathy in patients with rheumatoid arthritis
Spine, 06/01/09

Shimizu T et al. – Data show that space available for the spinal cord (SAC) was a reliable parameter for relating myelopathy in patients with upper cervical subluxation in RA. For the purpose to screen the patients with high risk for myelopathy, 14 mm or less was recommended as a cut-off point of SAC.

• An evaluation of diagnostic validity SAC at C1 level for myelopathy in RA pts
• 2 cohorts of RA pts were established:
  • Group A: 140 pts with myeopathy due to upper cervical involvement selected from the database
  • Group B: 99 pts with upper cervical subluxation, but not associated with myelopathy, selected from hospitalized pts
• Distributions of SAC at C1 level in both groups were evaluated
• Efficacy indexes for screening were calculated for these pts' population by previously demonstrated 2 criteria
• In addition, analysis according to receiver operating characteristic (ROC) curve was performed

• Average values of SAC were 11.1 mm in Group A and 16.5 mm in Group B
• When cut-off point for myelopathy was defined as ≤13 mm, sensitivity and specificity were 82% and 85%, respectively
• When it was defined as ≤14 mm, sensitivity increased (88%) while specificity decreased (74%)
• Accuracies by these 2 criteria were almost the same (83%, 82%)
• The left upper corner point of ROC curve was located between these 2 cut-off points

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