A 20-year study of spinal surgery in patients with rheumatoid arthritis

Abstract

Eighty-seven spine surgeries performed on rheumatoid arthritis patients between 2001 and 2020 were reviewed. The main lesions were cervical spine in 28 cases, thoracic spine in 1 case, and lumbar spine in 58 cases. The main trends were a significant increase in age and lumbar spine surgery, and a significant decrease in fusion surgery with subaxial subluxation; there was a significant increase in MTX or biologics use in surgery after 2011. The revision rate for implant use was 23% (18/77), and the revision rate was significantly higher in patients with a history of THA/TKA (46%/17%, p<0.05). 7 patients (8%) had postoperative infection, and 2 patients (2%) died within 1 year after surgery (including 1 during hospitalization). In recent years, with the introduction of biologics, the number of fixed surgeries due to rheumatoid cervical lesions has significantly decreased, and lumbar degenerative diseases now account for majority of cases, as in non-rheumatoid patients. On the other hand, the revision rate is significantly higher in cases of major joint replacement, which requires particularly careful follow-up.