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HomeReview of the conditionConsidering surgeryWho should consider spine surgery for rheumatoid arthritis?What happens without surgery?Surgical options Effectiveness Urgency Risks Managing risk Preparing for surgeryAbout the procedureRecovering from surgeryConclusion

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Spine Surgery for Rheumatoid Arthritis.

Edited By: Jens R. Chapman, M.D.
Last updated Wednesday, December 29, 2004

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Considering surgery

Who should consider spine surgery for rheumatoid arthritis?

RA patients who have unrelenting pain, experience loss of neurologic function, such as dexterity in hands and feet, or have progressive loss of spine stability as shown on X-rays should consider such surgery.

What happens without surgery?

The best case scenario includes ocasional neck and back pain necessitating anti-inflammatory medication use and soft neck collar with the patient maintaining an active life-style.

A worst case scenario might be sudden death through acute spinal cord compression in an area right below the skull.

Surgical options

Stabilization of the spine may be necessary in areas where the arthritis has led to unacceptable pain and instability. Such a procedure ("fusion") is nowadays carried out with resection of the involved joint, placement of a small bone graft taken from the pelvis into the former joint and stabilization with small titanium screws, rods and plates.

Effectiveness

Once a solid fusion is obtained, the results are permanent. Eighty-five per cent of RA patients with fusions report good or excellent relief of their preoperative symptoms.

Urgency

Should a spinal cord or nerve compression be manifest, surgical care should be considered with urgency (within weeks). In absence of neurologic concerns, a patient with RA can be followed serially with X-rays and examinations on an annual or semi-annual basis.

Risks

The most common risks of spine surgery in RA historically were surgical wound infections and failure of the spinal hardware to provide adequate stability to the spine. With the advent of modern spinal instrumentation systems and improved understanding of medical care needs of RA patients, these occurrences have dramatically decreased.

One in ten patients with a spine fusion performed ten years or more ago may experience increased pain in their spine due to instability at a level below a fusion. If this is noticed the previous fusion may have to be extended to include the newly affected levels.

Managing risk

Surgical wound infections or hardware failures may require repeat surgery. Infections will also require intravenous antibiotics given for several weeks.

Surgery for Rheumatoid arthritis of the spine at the University of Washington

If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-6293 to make an appointment.

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