Which imaging study is recommended for assessing cervical spine stability in a patient with rheumatoid arthritis prior to general anesthesia?

• A. Lateral X-ray of the cervical spine on flexion and extension
• B. MRI of the cervical spine in neutral position
• C. CT scan of the brain
• D. Ultrasound of the neck

Answer: (A)

Rheumatoid arthritis can cause cervical spine instability, especially at the atlas–axis joint, due to ligamentous damage and inflammatory pannus. Before general anesthesia, it’s crucial to know whether the neck will remain stable when the head and neck are manipulated for airway management. Flexion and extension lateral views of the cervical spine reveal dynamic instability by showing how the atlas moves relative to the dens. If the atlantodental interval widens or there is abnormal motion between the vertebrae on these positions, it indicates instability that could risk spinal cord injury during intubation or positioning. MRI in neutral may detect existing compression but won’t reveal unstable motion; CT of the brain isn’t relevant for spinal stability, and ultrasound cannot assess cervical spine dynamics.