• Kai-Uwe Lewandrowski, Paul P Park, Jeffrey M Baron, and Stephen L Curtin.
• Center for Advanced Spinal Surgery, Southwest Orthopaedic Surgery Specialists, PLC, 3395 N Campbell Avenue, Tucson, AZ 85719, USA. lewandk@comcast.net
• Spine J. 2006 Sep 1;6(5):529-33.

Background ContextInstability of the cervical spine is a common problem in patients with rheumatoid arthritis. The natural course of rheumatoid arthritis in the cervical spine is well documented. However, the true prevalence of occult fractures of the odontoid process in patients with rheumatoid arthritis is not known.PurposeTo draw attention to the possibility of occult, atraumatic fractures of the odontoid process in patients with rheumatoid arthritis.Study DesignWe report on two cases with previously unrecognized fractures of the odontoid process.MethodsIn this case series, we review the individual radiographic findings and clinical observations in two rheumatoid patients in whom a fracture of the odontoid process was diagnosed.ResultsEach one of these two rheumatoid patients had an unrecognized fracture of the odontoid process without any prior history of trauma. Their fracture was identified serendipitously during workup for neck pain.ConclusionsOccult, atraumatic fractures of the odontoid process may be found in patients with long-standing rheumatoid arthritis. This injury should be suspected if previously asymptomatic patients complain about new onset of neck pain without significant trauma.

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