Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France.
Department of Orthopaedic Surgery, Henri Mondor Hospital, AP-HP, University of Paris, East Créteil, France; Cell and Tissue Engineering for Musculoskeletal Disorders (Group 5)/Biology of the NeuroMuscular System (INSERM Team 10)/Mondor Institute for Biomedical Research, Creteil, France.
World Neurosurg. 2021 Oct;154:e109-e117. doi: 10.1016/j.wneu.2021.06.128. Epub 2021 Jul 2.
Rheumatoid arthritis (RA) is a risk factor of lumbar spine surgical failure. The interest of anterior lumbar fusion in this context remains unknown. This retrospective study aimed to compare the outcome of anterior-only fusions between RA patients and non-RA (NRA) patients to treat lumbar spine degenerative disorders.
NRA and RA groups including anterior-only fusion were compared. Clinical data (Visual Analog Scale score axial back pain scale, the Oswestry Disability Index, and a questionnaire of satisfaction regarding the surgical result); radiologic data (bone fusion, sagittal balance analysis); and adverse events were assessed using repeated measure 1-way analysis of variance.
The mean follow-up was 9.5 years (95% confidence interval [7.1-12.2]) for the RA group (n = 13) and 9.4 years (95% confidence interval [8.7-10.3]) for the NRA group (n = 36). Anterior fusion improved clinical outcome without any effect of RA (Visual Analog Scale score axial back pain scale; P < 0.001/Oswestry Disability Index; P = 0.01). The presence of RA influenced neither the satisfaction as the regards the surgical result nor spine balance nor bone fusion. Context of RA increased the surgical revision rate (10 patients [76.9%] for RA group vs. 3 patients [8.8%] for the NRA group; P = 0.001) because of the occurrence of an adjacent segment disease needing surgical revision (P = 0.028), especially the occurrence of intervertebral frontal dislocation (P = 0.02).
As noticed for posterior-only fusion, the anterior lumbar approach in RA patients does not seem to avoid the occurrence of an adjacent segment disease.
类风湿关节炎（RA）是腰椎手术失败的一个危险因素。在前路腰椎融合术治疗腰椎退变性疾病的情况下，其应用价值尚不清楚。本回顾性研究旨在比较 RA 患者和非 RA（NRA）患者前路融合术的结果。
比较 NRA 和 RA 组的前路融合术。临床数据（轴向腰痛视觉模拟评分、Oswestry 功能障碍指数和手术结果满意度问卷）；影像学数据（骨融合、矢状位平衡分析）；以及不良事件采用重复测量方差分析。
RA 组（n=13）的平均随访时间为 9.5 年（95%置信区间[7.1-12.2]），NRA 组（n=36）为 9.4 年（95%置信区间[8.7-10.3]）。前路融合术改善了临床结果，但不受 RA 的影响（轴向腰痛视觉模拟评分；P<0.001/Oswestry 功能障碍指数；P=0.01）。RA 的存在既不影响手术结果的满意度，也不影响脊柱平衡或骨融合。RA 增加了手术翻修率（RA 组 10 例[76.9%]，NRA 组 3 例[8.8%]；P=0.001），因为需要手术翻修的相邻节段疾病（P=0.028），尤其是发生椎间前脱位（P=0.02）。
与后路融合术一样，前路腰椎融合术在 RA 患者中似乎并不能避免相邻节段疾病的发生。
