Honda Shintaro, Murata Koichi, Sakamoto Masaki, Shiroshita Akihiro, Saka Natsumi, Otsuki Bungo, Shimizu Takayoshi, Sono Takashi, Masuda Soichiro, Shima Koichiro, Matsuda Shuichi
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Global Spine J. 2025 Jan 29:21925682251318265. doi: 10.1177/21925682251318265.
A systematic review and meta-analysis.
This study aimed to determine whether rheumatoid arthritis (RA) is associated with clinical outcomes following spinal surgery for lumbar spinal disorders.
MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were comprehensively searched for observational studies comparing clinical outcomes after lumbar spine surgery in patients with and without RA (>18 years). Quality assessment was conducted using the Quality in Prognosis Studies assessment tool. Pooled odds ratios (ORs) and hazard ratios were calculated for reoperation and surgical site infection by using a random effects model. Subgroup analyses were conducted to examine the effect of surgery type.
Seven studies with 72,969 patients, including 7518 patients with RA, were analyzed. All studies had a moderate risk of bias. Patients with RA had a significantly higher odds of reoperation (OR: 5.57; 95% confidence interval [CI]: 1.10-28.26; I2 = 92%; = 0.04) and higher odds of surgical site infection (OR: 1.47; 95% CI: 1.28-1.69; I2 = 2%; < 0.01). No statistically significant difference was found in reoperation-free survival between patients with RA and those without RA (hazard ratio: 1.15; 95% CI: 0.94-1.40; I2 = 100%; = 0.16). Patients with RA had higher complication rates, with incidence rates ranging from 13.5% to 57%, compared with those without RA.
Compared with patients without RA, patients with RA may be more likely to undergo reoperations and suffer from complications following surgery for lumbar spine lesions.
系统评价与荟萃分析。
本研究旨在确定类风湿性关节炎（RA）是否与腰椎疾病脊柱手术后的临床结局相关。
全面检索MEDLINE、Embase、Cochrane图书馆和国际临床试验注册平台，以查找比较有或无RA（>18岁）患者腰椎手术后临床结局的观察性研究。使用预后研究质量评估工具进行质量评估。采用随机效应模型计算再次手术和手术部位感染的合并比值比（OR）和风险比。进行亚组分析以检验手术类型的影响。
分析了7项研究，共72969例患者，其中包括7518例RA患者。所有研究均存在中度偏倚风险。RA患者再次手术的几率显著更高（OR：5.57；95%置信区间[CI]：1.10 - 28.26；I² = 92%；P = 0.04），手术部位感染的几率也更高（OR：1.47；95%CI：1.28 - 1.69；I² = 2%；P < 0.01）。RA患者和非RA患者在无再次手术生存期方面未发现统计学显著差异（风险比：1.15；95%CI：0.94 - 1.40；I² = 100%；P = 0.16）。与非RA患者相比，RA患者的并发症发生率更高，范围为13.5%至57%。
与非RA患者相比，RA患者在腰椎病变手术后可能更有可能接受再次手术并出现并发症。
