Comparison of adult spinal deformity patients with and without rheumatoid arthritis undergoing primary non-cervical spinal fusion surgery: a nationwide analysis of 52,818 patients (original) (raw)
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Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis
Journal of Neurosurgery: Spine, 2015
OBJECT In this study, the authors compared outcomes and complications in patients with and without rheumatoid arthritis (RA) who underwent surgery for spinal deformity. METHODS The authors searched the Johns Hopkins University database for patients with RA (Group RA) and without RA (Group NoRA) who underwent long spinal fusion for scoliosis by 3 surgeons at 1 institution from 2000 through 2012. Groups RA and NoRA each had 14 patients who were well matched with regard to sex (13 women/1 man and 12 women/2 men, respectively), age (mean 66.3 years [range 40.5–81.9 years] and 67.6 years [range 51–81 years]), follow-up duration (mean 35.4 months [range 1–87 months] and 44 months [range 24–51 months]), and number of primary (8 and 8) and revision (6 and 6) surgeries. Surgical outcomes, invasiveness scores, and complications were compared between the groups using the nonpaired Student t-test (p < 0.05). RESULTS For Groups RA and NoRA, there were no significant differences in the average...
Cervical spine surgery in patients with rheumatoid arthritis: an appraisal
Annals of the Rheumatic Diseases, 1996
Objectives-To review the outcome of surgery undertaken to stabilise the neck in patients with rheumatoid arthritis performed over a five year period, to compare the results with those of previous reports, and to identify factors that may predict surgical outcome. Methods-Outcome was assessed at time ofdischarge from hospital after surgery by review of patients' notes, and at follow up by patient interview, clinical examination, anonymous questionnaire, and cervical spine radiograph. The Ranawat classification of neurological impairment and Steinbrocker functional classification were used.
Lumbar fusion outcomes in patients with rheumatoid arthritis
European Spine Journal, 2008
Although outcomes after cervical fusion in rheumatoid arthritis (RA) patients are widely published, outcomes of lumbar fusion in RA patients has not been reported. Ninteen patients with RA, identified using ICD-9 and CPT codes, who underwent instrumented posterolateral lumbar fusion were matched for age, gender, smoking status, date, and level of surgery to a contemporaneous non-RA group. Medical records and radiographs were reviewed by the primary author who had no role in the treatment of these patients. The average age was 64 years in the RA group and 65 years in the non-RA group. The male to female ratio was 2:17 and 1:18, respectively. There were three smokers and two diabetics in each group. An average of 1.5 levels was fused in each group. Average follow-up was 24 and 27 months, respectively. In the RA group, 15 patients were taking DMARDs with 7 of those also taking oral steroids; 4 patients were taking NSAIDs only. There were seven complications (37%) in the RA group versus four (21%) in the non-RA group; wound infections in three patients (16%) in the RA group versus one (5%) in the non-RA group; and non-union in two patients (11%) in the RA group versus three (16%) in the non-RA group. Clinical outcomes were similar between the two groups with 74% of patients achieving good to excellent results in the RA group compared to 63% in the non-RA group (p = 0.692). Surgeons and their RA patients who undergo an instrumented lumbar fusion can expect a slightly higher complication rate than patients without RA which may be related to osteopenia and immunosuppression.
BMC Musculoskeletal Disorders, 2014
Background: The aim of this study was to examine the clinical characteristics of rheumatoid arthritis (RA) patients who underwent cervical spine surgery using a multicenter observational database. Methods: We obtained data from a nationwide observational cohort database of patients with rheumatic diseases (National Database of Rheumatic Diseases by iR-net in Japan (NinJa)) for the fiscal years 2003 to 2011. A total of 39 out of 60 patients who underwent cervical spine surgery for a RA-related cause and whose data were available for two consecutive years (to assess the preoperative patient status) were chosen as cases. Patients with a non-RA-related cause of surgery (e.g., trauma) were excluded. First, we compared the patient characteristics between the cases and total patients in the same fiscal year. Next, 106 eligible controls, who were defined as RA patients enrolled in the same fiscal year as the case subjects, who were matched for age, gender and disease duration (within ±1 year), were selected. We compared the demographic data between the two groups. We also calculated the percentage of patients who underwent cervical spine surgery (surgeries/total number of patients) in fiscal years 2003 to 2011. Results: Although the proportion of patients using biologics linearly increased during study period, the percentage of patients undergoing cervical spine surgeries remained unchanged, at approximately 0.15%. These cases had more tender joints (3 vs. 1, p < 0.01) and exhibited a significantly higher Modified Health Assessment Questionnaire (MHAQ) score (1.13 vs. 0.5, p < 0.01), C-reactive protein (CRP) (1.5 vs. 0.36, p < 0.01), and disease activity score (DAS) 28-CRP (3.63 vs. 2.81, p < 0.01) compared to the controls. Conclusions: Our study revealed that RA patients requiring cervical spine surgery have a higher disease activity (as represented by the DAS28-CRP) and are more functionally disabled (as represented by the MHAQ) than control patients.
Surgical management of cervical spine instability in Rheumatoid Arthritis patients
Acta reumatologica portuguesa, 2014
Aim: Cross-sectional study that aims to evaluate the results of cervical spine surgeries due to rheumatoid arthritis (RA) instability, between January of 2000 and of 2012 in a main Portuguese centre. Methods: Patients followed on Rheumatology submitted to cervical spine fusion due to atlantoaxial (AAI), sub-axial (SAI) or cranio-cervical (CCI) instabilities between 2000-2012 were included. Information about the surgical procedure and associated complications was gathered and imagiologic and clinical indexes before and after surgery (as anterior and posterior atlanto-axial interval and Ranawat index) were evaluated and compared using adequate statistics. Results: Forty-five patients with RA were included: 25 with AAI, 13 with CCI and 7 with SAI. Ten AAI and 4 CCI patients were submitted to wiring stabilization techniques; 15 AAI and 9 CCI patients to rigid ones; and in all patients with SAI an anterior cervical arthrodesis was chosen. There is a significant increase in PADI and a dec...
Cervical laminectomy without fusion in patients with rheumatoid arthritis
Journal of neurosurgery, 1999
N patients with long-term rheumatoid arthritis cervical spine involvement is frequently demonstrated. It has been suggested that in more than half of the patients with rheumatoid multiple-joint disease radiographically documented changes are due to cervical spine instability. 1,10 Approximately half of the patients in whom instability is revealed radiographically also show clinical signs of instability or symptoms of medullary compression. 10,16 Symptoms include neck and head pain, neck stiffness, and various degrees of peripheral neurological involvement as a result of compression and/or stretching of the brainstem and upper spinal cord. The most common radiographic finding is atlantoaxial subluxation, which is caused by the destructive inflammatory process and laxity of the transverse ligament. Subaxial subluxation develops later and can result in a stepladder deformity. 18 Patients with severe cases develop odontoid erosion and cranial settling with superior migration of the odontoid into the foramen magnum. Medullary compression may be caused by inflammatory tissue (pannus) that bulges into the spinal canal in combination with narrowing of the spinal canal due to subluxated vertebrae. Because of the narrow diameter of the spinal canal below the level of C-2, even a slight subluxation may result in cord compression. Magnetic resonance (MR) imaging is the diagnostic method of choice to reveal the extent and type of cord compression (Fig. 1). Because reduction of subaxial subluxations is often difficult, a decompressive laminectomy becomes necessary. It is generally believed that fusion of the affected segments is necessary to provide symptomatic relief and to protect the patient from further cervical spine destruction and medullary compression. 1,14 In patients with advanced disease and poor bone quality, bone fusion may be impossible. Decompressive laminectomy may still be necessary for patients in whom myelopathy is secondary to spinal cord compression. We performed this prospective study to determine whether cervical laminectomy without simultaneous fusion results in spinal instability. Clinical Material and Methods During a nearly 4-year period, we performed surgery in 14 patients with long-term seropositive rheumatoid arthritis and one patient with long-term juvenile ankylosing spondylitis; all patients had evidence of spinal cord compression on MR imaging as well as clinical signs of myelopathy. The median duration of the rheumatoid disease was 31 years (range
Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery
International journal of rheumatology, 2015
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting a significant percentage of the population. The cervical spine is often affected in this disease and can present in the form of atlantoaxial instability (AAI), cranial settling (CS), or subaxial subluxation (SAS). Patients may present with symptoms and disability secondary to these entities but may also be neurologically intact. Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial. The aim of this paper is to describe the pathology, pathophysiology, clinical manifestations, and diagnostic evaluation of rheumatoid arthritis in the cervical spine in order to provide a better understanding of the indications and options for surgery. Both the medical and surgical treatment options for RA have improved, so has the prognosis of the cervical spine disease. With the advent of disease modifying antirheumatic drugs (DMARDs), fewer ...
Rheumatology International
The purpose of the present systematic review was to describe the diagnostic evaluation of rheumatoid arthritis in the cervical spine to provide a better understanding of the indications and options of surgical intervention. We performed a literature review of Pub-med, Embase, and Scopus database. Upon implementing specific inclusion and exclusion criteria, all eligible articles were identified. A total of 1878 patients with Rheumatoid Arthritis (RA) were evaluated for cervical spine involvement with plain radiographs. Atlantoaxial subluxation (AAS) ranged from 16.4 to 95.7% in plain radiographs while sub-axial subluxation ranged from 10 to 43.6% of cases. Anterior atlantodental interval (AADI) was found to between 2.5 mm and 4.61 mm in neutral and flexion position respectively, while Posterior Atlantodental Interval (PADI) was between 20.4 and 24.92 mm. 660 patients with RA had undergone an MRI. A pannus diagnosis ranged from 13.33 to 85.36% while spinal cord compression was reporte...