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

So Kato; Hideki Nakamoto; Yoshitaka Matsubayashi; Yuki Taniguchi; Toru Doi; Yuichi Yoshida; Akiro Higashikawa; Yujiro Takeshita; Masayoshi Fukushima; Takashi Ono; Nobuhiro Hara; Rentaro Okazaki; Hiroki Iwai; Masahito Oshina; Shurei Sugita; Shima Hirai; Kazuhiro Masuda; Sakae Tanaka; Yasushi Oshima; University of Tokyo Spine Group

doi:10.1186/s12891-022-05326-5

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

BMC Musculoskelet Disord. 2022 Apr 22;23(1):380. doi: 10.1186/s12891-022-05326-5.

Authors

So Kato¹, Hideki Nakamoto², Yoshitaka Matsubayashi², Yuki Taniguchi², Toru Doi², Yuichi Yoshida³, Akiro Higashikawa⁴, Yujiro Takeshita⁵, Masayoshi Fukushima⁶, Takashi Ono⁷, Nobuhiro Hara⁸, Rentaro Okazaki⁹, Hiroki Iwai¹⁰, Masahito Oshina¹¹, Shurei Sugita¹², Shima Hirai¹³, Kazuhiro Masuda¹⁴, Sakae Tanaka², Yasushi Oshima²; University of Tokyo Spine Group

Collaborators

University of Tokyo Spine Group:
Yasushi Oshima, Naohiro Kawamura, Akiro Higashikawa, Nobuhiro Hara, Takashi Ono, Yujiro Takeshita, Yuki Taniguchi, Yoshitaka Matsubayashi, So Kato

Affiliations

¹ Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. sokato@g.ecc.u-tokyo.ac.jp.
² Department of Orthopaedic Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
³ Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
⁴ Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kizukisumiyoshi-cho, Nakahara-ku, Kawasaki, 211-8510, Japan.
⁵ Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukue-Chō, Kōhoku-Ku, Yokohama, 222-0036, Japan.
⁶ Spine Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
⁷ Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan.
⁸ Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1 Kyonancho, Musashino, Tokyo, 180-8610, Japan.
⁹ Department of Orthopedic Surgery, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama, 330-8553, Japan.
¹⁰ Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo, 133-0056, Japan.
¹¹ Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
¹² Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
¹³ Department of Orthopedic Surgery, Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa, 252-0392, Japan.
¹⁴ Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.

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.

Keywords: Degenerative lumbar disease; EuroQOL; Lumbar spinal stenosis; Numerical rating scale; Oswestry Disability Index; Patient-reported outcomes; Posterior surgery; Propensity score matching; Rheumatoid arthritis; Short-form 12 physical component summary.

Publication types

Multicenter Study

MeSH terms

Arthritis, Rheumatoid* / surgery
Back Pain / diagnosis
Female
Humans
Lumbar Vertebrae* / surgery
Male
Propensity Score
Prospective Studies
Quality of Life
Retrospective Studies
Steroids
Treatment Outcome

Substances

Steroids