Lumbar spine surgery in patients with rheumatoid arthritis (RA): what affects the outcomes

Publication date: Available online 1 July 2017
Source:The Spine Journal
Author(s): Shoji Seki, Norikazu Hirano, Isao Matsushita, Yoshiharu Kawaguchi, Masato Nakano, Taketoshi Yasuda, Hiraku Motomura, Kayo Suzuki, Yasuhito Yahara, Kenta Watanabe, Hiroto Makino, Tomoatsu Kimura
Background ContextWhile the cervical spine is only occasionally involved in rheumatoid arthritis (RA), involvement of the lumbar spine is even less common. A few reports on lumbar spinal stenosis in patients with RA have appeared. Although disc space narrowing occurs in aging, postoperative ASD in RA patients has not been subject to much analysis.PurposeTo investigate differences in adjacent segment disease (ASD) and clinical outcomes between lumbar spinal decompression with and without fusion in patients with rheumatoid arthritis (RA).Study Design/SettingRetrospective comparative study.Patient SampleA total of 52 RA patients who underwent surgery for lumbar spinal disorders were included. Twenty-seven patients underwent decompression surgery with fusion and 25 underwent decompression surgery alone.Outcome MeasuresIntervertebral disc space narrowing and spondylolisthesis of the segment immediately cranial to the surgical site were measured using three-dimensional volume rendering software. Pre- and post-operative evaluation of RA activity and Japanese Orthopaedic Association (JOA) scores were conducted.MethodsAll patients had preoperative and annual postoperative lumbar radiographs and were followed for a mean of 5.1 years (range 3.5-10.9 years). Pre- and postoperative (2 years after surgery) JOA scores were recorded and any postoperative complications were investigated. Degrees of intervertebral disc narrowing and spondylolisthesis at the adjacent levels were evaluated on radiographs and compared between the two groups. Analysis was performed to look for any correlation between ASD and RA disease activity.ResultsPostoperative JOA scores were significantly improved in both groups. The rate of revision surgery was significantly higher in the fusion group than in the non-fusion group. The rate of ASD was significantly greater in the fusion group than in the non-fusion group at the final follow-up examination. Both matrix metalloproteinases 3 (MMP-3) and the 28-joint disease activity score incorporating C-reactive protein levels (DAS28CRP) were significantly associated with the incidence and severity of ASD.ConclusionsASD and the need for revision surgery were significantly higher in the fusion group than in the non-fusion group. A preoperative high MMP-3 and DAS28CRP are likely to be associated with postoperative ASD.



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