Summary: The management and outcomes of surgery for thoracolumbar scoliosis in patients with rheumatoid arthritis (RA) is not known. Our experience with long spinal fusions (≥9 levels) in RA patients demonstrates high complication and revision rates.
Introduction: Outcomes of long spinal fusions for scoliosis in patients with rheumatoid arthritis (RA) are not known. Our objective was to document surgical outcome and complications associated with the management of scoliosis in patients with rheumatoid arthritis.
Methods: Retrospective review of prospectively collected data from 2000 ‐ 2009 for patients with RA who underwent long spinal fusions for scoliosis. Our inclusion criteria were: RA, nine or higher vertebral levels fused and a diagnosis of degenerative or idiopathic scoliosis. We excluded patients that had eight or fewer levels fused, non‐RA patients and patients who did not have scoliosis. Demographics, co‐morbidities, levels fused, complications and revisions were recorded.
Results: Ten consecutive RA patients who met the inclusion criteria were identified. There were 9 females and 1 male. Average age at surgery was 65.6 (40.5‐81.9). There were 0 smokers and 1 patient with diabetes mellitus. Average follow up was 40.3 month (0.03 ‐ 88.5). 6 cases were index spinal fusions and 4 cases were revisions. All patients had degenerative scoliosis, 8 had lumbar stenosis and 2 had kyphosis. RA medications used included 8 oral steroids, 7 disease modifying antirheumatic drugs (DMARDs) and 1 biologic DMARD. There were an average of 10.5 levels fused (9 ‐17). 8 cases were posterior only and 2 were combined anterior/posterior. Average estimated blood loss was 3.1 L (1.3 ‐ 5). Average hospital length of stay was 14.2 days (5 ‐55). 12 complications in 8 patients included: incidental durotomy (2), pseudoarthrosis (2), epidural hematoma (2), post‐op death 2nd to respiratory failure (1), distal junctional kyphosis (1), pulmonary embolism (1), respiratory failure requiring tracheotomy (1), neurologic deficit(1), deep infection (1). 7 patients required a revision procedure.
Conclusion: Long spinal fusions in patients with RA are associated with high rates of complications and revisions.
Significance: This is the first study documenting surgical outcomes following the management of scoliosis in patients with rheumatoid arthritis.