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Changing Trends in Cervical Spine Fusions in Patients With Rheumatoid Arthritis

Stein, Benjamin E. MD; Hassanzadeh, Hamid MD; Jain, Amit MD; Lemma, Mesfin A. MD; Cohen, David B. MD; Kebaish, Khaled M. MD

doi: 10.1097/BRS.0000000000000376
Cervical Spine

Study Design. Retrospective data analysis.

Objective. To compare the trends in primary cervical spine fusion procedures in patients with rheumatoid arthritis (RA) against those in the general population.

Summary of Background Data. RA severely impacts multiple joints in the body and can result in substantial deformity and functional impairment. Cervical spine involvement is common. In the past decade, treatment for RA has changed substantially with the introduction of biologically based, disease-modifying antirheumatic medications. Recent literature has shown decreasing rates of total joint arthroplasty in patients with RA.

Methods. Cases of cervical spine fusion in the general population and in patients with RA were identified from the Nationwide Inpatient Sample from 1992 through 2008. US population counts were obtained from the Census Bureau. Data were analyzed with computer software (significance, P < 0.05 for all analyses). Linear regression models were used to describe national rates of cervical spine fusion in patients with and without RA.

Results. There was a marked increase in the number of cervical fusion procedures in the studied population. Over time, the incidence of atlantoaxial fusion increased in the general population (P < 0.01) and decreased in patients with RA (P < 0.01). Compared with the general population, patients with RA had a significantly lower rate of increase in the incidence of posterior cervical fusion (P < 0.01) and a significantly higher rate of increase in the incidence of anterior cervical fusion (P < 0.01).

Conclusion. In the US, the absolute number of primary cervical fusion procedures from 1992 through 2008 increased in the general population and in patients with RA. However, the patients with RA had a significantly lower incidence of undergoing atlantoaxial and posterior cervical surgical procedures than did the general population.

Level of Evidence: 2

Patients with rheumatoid arthritis had a significantly lower incidence of undergoing atlantoaxial and posterior cervical fusion surgical procedures than the general population. This finding may be the result of better control over disease progression through biological agent therapy.

From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.

Address correspondence and reprint requests to Khaled M. Kebaish, MD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, A665, Baltimore, MD 21224; E-mail: ehenze1@jhmi.edu

Acknowledgment date: November 27, 2013. Revision date: February 20, 2014. Acceptance date: April 4, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, payment for development of educational presentations.

© 2014 by Lippincott Williams & Wilkins