A group of researchers recently compared trends in primary cervical fusion procedures for patients with rheumatoid arthritis against the general population and published their results in Spine.
The study includes data from the Nationwide Inpatient Sample from 1992 to 2008. The researchers used linear regression models to describe national rates of cervical spine fusion in RA and non-RA patients.
Here are five trends noted in the study:
1. There was a "marked" increase in cervical fusion procedures during the study period for both the general population and people with RA. A study published in Spine earlier this year showed these seven trends for cervical spine surgery patients from 2002 to 2011:
• Anterior cervical fusion and posterior cervical fusion numbers had statistically significant increases over time
• There was an uptrend in patient age
• There was an uptrend in the comorbidity burden
• BMP utilization increased throughout the period studied, but demonstrated a decline after peaking in 2007
• Posterior cervical fusion showed the greatest comorbiditiy, length of stay, costs and mortality
• Hospital length of stay and mortality remained flat over time
• Significant increases in costs during this time period were noted, potentially do to advances in surgical technology and instrumentation
2. Atlantoaxial fusion increased in the general population but decreased in patients with RA. A 2004 article in The Spine Journal reported that 86 percent of patients with rheumatoid arthritis have cervical spine involvement with lesions that are clinically asymptomatic or symptoms that are "erroneously attributed to peripheral manifestation of the patient's rheumatoid disease."
3. The incidence of posterior cervical fusion increased at a significantly lower rate in patients with RA compared with the general population. The study published in The Spine Journal found if a large percentage of RA patients with cervical spine involvement will progress toward instability if they are left untreated. "Early diagnosis and treatment is imperative; however surgical intervention should be considered carefully because associated morbidity and mortality is high," concluded the study authors.
4. Anterior cervical fusion increased at a significantly higher rate among RA patients when compared with the general population. A 2001 study of patients with rheumatoid arthritis who underwent cervical spine surgery because of occipital neuralgia or cervical myelopathy experienced successful two-year outcomes. However, within two years 27 percent of the patients had died, but in most patients the cause of death was not related to surgery. The highest mortality was found among patients with quadriparesis and very poor functional capacity.
5. Literature shows decreasing total joint arthroplasty rates in patients with RA. Rheumatoid arthritis treatment changed significantly over the past several years after biologically-based, disease modifying antirheumatic medications were introduced. The disease has a severe impact on multiple joints and can result in deformity and functional impairment.
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