Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea.
Eur Spine J. 2019 Sep;28(9):2145-2150. doi: 10.1007/s00586-017-5220-6. Epub 2017 Jul 28.
To the best of our knowledge, there has been no report regarding rheumatoid arthritis associated with spinal neuroarthropathy and combined double-level isthmic spondylolisthesis. Here, we report a rare case of spinal neuroarthropathy with double-level isthmic spondylolisthesis in a rheumatoid arthritis (RA) patient. A 56-year-old female patient under medical treatment for RA during the last 13 years presented aggravating radiating pain to her right lower extremity and a limping gait developed 4 months ago. The disease activity of RA had remained low for a long time. Serial radiographs during last 8-year follow-up showed progressive dislocation at L4-L5 and L5-S1 with double-level isthmic spondylolisthesis and severe destructive status at the last follow-up. The patient underwent decompression and circumferential fusion with sacropelvic fixation and acceptable reduction was obtained.
A RA patient with double-level isthmic spondylolisthesis showed a progressive destructive lesion. In addition to clinical presentations, the imaging findings were very similar to ones of spinal neuroarthropathy. The authors conclude that this Grand Round case probably had SNA secondary to RA and that this, combined with two-level isthmic spondylolisthesis, resulted in her rapidly progressing destructive lumbar lesion.
据我们所知，目前尚无关于类风湿关节炎伴脊柱神经关节病和双节段峡部性脊椎滑脱的报道。在此，我们报告一例罕见的类风湿关节炎（RA）伴脊柱神经关节病和双节段峡部性脊椎滑脱病例。一名 56 岁女性患者，RA 病史 13 年，长期病情活动度低，4 个月前出现右下肢放射痛加重和跛行。在过去 8 年的随访中，连续的 X 线片显示 L4-L5 和 L5-S1 进行性双侧峡部性脊椎滑脱，且在最后一次随访时出现严重的破坏性病变。患者接受了减压和全脊柱融合固定术，获得了可接受的复位。
一例双节段峡部性脊椎滑脱的 RA 患者表现为进行性破坏性病变。除了临床表现外，影像学表现与脊柱神经关节病非常相似。作者认为，这个病例可能是由 RA 引起的 SNA，再加上双节段峡部性脊椎滑脱，导致其迅速进展的破坏性腰椎病变。
