Postoperative outcomes after degenerative lumbar spine surgery in rheumatoid arthritis patients -a propensity score-matched analysis

BMC Musculoskeletal Disorders

University of Tokyo Spine Group¹  So Kato²  Toru Doi²  Hideki Nakamoto²  Sakae Tanaka²  Yoshitaka Matsubayashi²  Yasushi Oshima²  Yuki Taniguchi²  Akiro Higashikawa³  Yujiro Takeshita⁴  Nobuhiro Hara⁵  Masahito Oshina⁶  Shima Hirai⁷  Rentaro Okazaki⁸  Shurei Sugita⁹  Kazuhiro Masuda^1,10  Takashi Ono^1,11  Yuichi Yoshida^1,12  Hiroki Iwai^1,13  Masayoshi Fukushima^1,14 

[1] ;Department of Orthopaedic Surgery, the University of Tokyo;Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital;Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital;Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital;Department of Orthopedic Surgery, NTT Medical Center Tokyo;Department of Orthopedic Surgery, Sagamihara National Hospital;Department of Orthopedic Surgery, Saitama Red Cross Hospital;Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital;Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center;Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center;Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center;Iwai Orthopaedic Medical Hospital;Spine Center, Toranomon Hospital;

关键词: Degenerative lumbar disease;    Lumbar spinal stenosis;    Rheumatoid arthritis;    Posterior surgery;    Patient-reported outcomes;    Numerical rating scale;   

DOI  :  10.1186/s12891-022-05326-5

来源: DOAJ

【 摘 要 】

Abstract Background Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis. Methods Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups. Results Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids. Conclusions RA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.

【 授权许可】

Unknown