Long-term outcomes of surgical treatment of cervical spine involvement in rheumatoid arthritis.

Abstract

Purpose: Rheumatoid arthritis (RA) is a systemic disorder that affects the cervical spine (CS). Synovial inflammation can disrupt spinal stability, leading to conditions such as atlantoaxial and/or subaxial subluxation, vertical settling, and combined instability. Although symptoms may appear in a minority of patients, they are commonly observed in those with advanced diseases. Myelopathy can develop in about 2.5% of patients with long-standing RA. Surgical treatment is indicated for the presence of myelopathy, progressive neurological deficit and/or chronic untreatable pain. The objective of this study is to evaluate the long-term outcomes following surgical treatment of CS involvement in patients with RA and to review the existing literature.

Materials and methods: The present study is a retrospective and descriptive review of 17 patients with cervical involvement caused by RA who underwent surgery between 2000 and 2022. Collected data comprised the type of cervical lesion, the surgical approach and the pre-surgical, post-surgical and current neurological status.

Results: Most patients were women (70,58%) and the mean age at surgery was 51,17 years. Myelopathy was present in 12 patients at the time of surgery. Ten patients improved the post-surgical Ranawat score, while seven remained stable. One patient died from post-surgical complications (5,88% of fatal events), and four patients passed away during the follow-up period.

Discussion and conclusions: Surgical treatment of the cervical manifestation of RA provides benefits, improving quality of life and/or detaining the progression of the neurological damage. Even though the results are encouraging, surgery is not risk-free.