Abstract
Many surgical treatments for spinal lesions associated with rheumatoid arthritis (RA) have been reported. Although most of the reports are related to the cervical spine, involvement of the lumbar spine has also been reported in a small number of cases. A 73 year old woman with a seven years history of classical RA was admitted to our hospital suffering from acute low back pain and numbness in both legs. X-ray film revealed a burst fracture at L4. MRI revealed compression of dural sacs due to retropulsed bony fragment. A two-stage anterior and posterior spinal fixation was performed. Postoperatively, enlargement of the lumbar canal and incorporation of grafted bone, as well as the sequential collapse of the upper level vertebra were noted. The RA patients who receive glucocorticoid develop severe osteoporosis. The risk of compression fractures was found to be more strongly related to the daily dose rather than the cumulative dose of glucocorticoid. We suggest that bisphosphonates should be administered at an earlier stage for osteoporosis resulting from RA and glucocorticoid.
