Article: PDF OnlyShiau John S. C.; Arginteanu, Marc S.; Perin, Noel I.Neurosurgery Quarterly: September 1998 - p 180-190 Buy Abstract Summary Rheumatoid arthritis and other bone-softening diseases such as Paget's disease, osteogenesis imperfecta, rickets, osteomalacia, and hyperparathyroidism have the potential to destabilize the upper cervical spine. In these disease settings, the relation between the occiput, axis, and atlas may be altered and destabilized. This paper reviews the anatomy, clinical presentation, and pathogenesis of the different diseases, as well as their medical and surgical management at the occipitocervical junction. © Williams & Wilkins 1998. All Rights Reserved.