Background Since the appearance of biological DMARDs in Japan, disease control of rheumatoid arthritis has been ameliorated. Inflamed synovitis and destructive arthritis declined dramatically, which resulted in a decrease in the number of synovectomy and joint prosthesis gradually. On the other hand, surgeries for hand or foot disorders have been increasing. However, it is unclear about the surgery for cervical spine disorder.
Objectives We clarified the change in the surgical treatments for cervical spine disorder related to RA patients at our institution.
Methods From 2001 to 2015, we identified 71 RA patients with a cervical spine surgery. The mean age was 65.4 years (range, 44–90 years). The patients consisted 11 males and 60 females. The mean disease duration was 20 years (range, 0–52 years). They were classified into three subgroups according to the affected level: the upper lesions (UL) such as atlantoaxial subluxation, the middle and lower lesions (MLL) including subaxial subluxation, and the expanded lesions (EL) which have both features. Individual groups were assessed the change of the number of surgical treatment. In addition, we divided the period into first seven years (from 2001 to 2007) and last eight years (from 2008 to 2015), and compared each other.
Results There were 38 patients in UL, 25 patients in MLL and 8 patients in EL. Most patients in UL were underwent atlantoaxial fixation by Magerl and Brooks procedure, and the number of them was constant throughout the entire period. Occipito-cervical fusion has been decreasing. Although there were much surgeries of MLL disorder in last 8 years than that in first 7 years, most of them did not have RA change such as endplate erosion and subluxation.
Conclusions There was no significant change in EL throughout all periods. In conclusion, surgeries for cervical spine disorder of RA patients remained in our institute. However, disorders related to RA within them, especially MLL, were decreasing. it indicates that expansion of RA remission has led to the reduction of cervical spine surgeries with RA change.
Disclosure of Interest None declared