title: The pitfalls in surgical management of lumbar canal stenosis associated with rheumatoid arthritis.
abstract: There have been few clinical studies in the area of cervical spine that focused on surgery for treating degenerative lumbar disease in patients with rheumatoid arthritis (RA). High rates of wound complications and instrumentation failure have been reported more for RA than for non-RA patients, although clinical outcomes are similar between the two groups. Lumbar canal stenosis in RA is caused not only by degeneration but also by RA-related spondylitis, which includes facet arthritis and inflammation around the vertebral endplate. The pitfalls in surgical management of lumbar canal stenosis in RA patients are highlighted in this study. The study reviewed 12 patients with RA, who were surgically treated for lumbar canal stenosis. Two out of five patients with pulmonary fibrosis died of worsened pulmonary condition, even though there were no perioperative pulmonary complications. Two patients with pedicle screw fixation showed no instrumentation failure, but two patients with spinous process fixation needed re-operation or vertebral fracture. Surgical treatment for lumbar canal stenosis in RA patients needs to be individually adjusted. Preoperative assessments and treatments of pulmonary fibrosis and osteopenia are essential. Surgery for lumbar canal stenosis with RA should be deferred for patients with advanced pulmonary fibrosis because of its potential life-threatening risk. Fusion surgery is indicated only in patients with kyphosis or severe symptoms caused by intervertebral instability. Pedicle screw fixation with hydroxyapatite granules or sublaminar tape is recommended. Closer follow-up after surgery is necessary because of possible delayed wound infection, instrumentation failure, pathological fracture, and respiratory deterioration.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University.
authors.forename: Tetsuryu
authors.initials: T
authors.lastname: Mitsuyama
authors.forename: Motoo
authors.initials: M
authors.lastname: Kubota
authors.forename: Masahito
authors.initials: M
authors.lastname: Yuzurihara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mizuno
authors.forename: Ryo
authors.initials: R
authors.lastname: Hashimoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Ando
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001851:Bone Diseases, Metabolic / Q000150:complications; D001863:Bone Screws; D019299:Decompression, Surgical / Q000379:methods*; D004868:Equipment Failure; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000209:etiology / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013166:Spondylitis / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000209:etiology