Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis

Object: In this study, the authors compared outcomes and complications in patients with and without rheumatoid arthritis (RA) who underwent surgery for spinal deformity.

Methods: The authors searched the Johns Hopkins University database for patients with RA (Group RA) and without RA (Group NoRA) who underwent long spinal fusion for scoliosis by 3 surgeons at 1 institution from 2000 through 2012. Groups RA and NoRA each had 14 patients who were well matched with regard to sex (13 women/1 man and 12 women/2 men, respectively), age (mean 66.3 years [range 40.5-81.9 years] and 67.6 years [range 51-81 years]), follow-up duration (mean 35.4 months [range 1-87 months] and 44 months [range 24-51 months]), and number of primary (8 and 8) and revision (6 and 6) surgeries. Surgical outcomes, invasiveness scores, and complications were compared between the groups using the nonpaired Student t-test (p < 0.05).

Results: For Groups RA and NoRA, there were no significant differences in the average number of levels fused (10.6 [range 9-17] vs 10.3 [range 7-17], respectively; p = 0.4), the average estimated blood loss (2892 ml [range 1300-5000 ml] vs 3100 ml [range 1700-5200 ml]; p = 0.73), or the average invasiveness score (35.5 [range 21-51] vs 34.5 [range 23-58]; p = 0.8). However, in Group RA, the number of major complications was significantly higher (23 vs 11; p < 0.001), the number of secondary procedures was significantly higher (14 vs 6; p < 0.001), and the number of minor complications was significantly lower (4 vs 12; p < 0.001) than those in Group NoRA.

Conclusions: Long spinal fusion in patients with RA is associated with higher rates of major complications and secondary procedures than in patients without RA.