Objective:

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-rheumatoid arthritis (NRA) patients to treat lumbar spine degenerative disorders.

Methods:

NRA and RA groups including anterior-only fusion were compared. Clinical data (visual Analog Score axial back pain scale (VAS-B), the Oswestry Disability Index (ODI) and a questionnaire of satisfaction as regards the surgical result), radiologic data (bone fusion, sagittal balance analysis) and adverse events were assessed using repeated measure one-way ANOVA.

Results:

The mean follow-up was 9.5 years (95% CI [7.1-12.2]) for RA group (n=13) and 9.4 years (95% CI [8.7-10.3]) for NRA group (n=36). Anterior fusion improved clinical outcome without any effect of RA (VAS-B; p<0.001 / ODI; 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 versus (vs.) 3 patients (8.8%) for NRA group; p=0.001) because of the occurrence of ASD needing surgical revision (p=0.028) especially the occurrence of intervertebral frontal dislocation (p=0.02).

Conclusion:

As noticed for posterior-only fusion, anterior lumbar approach in RA patients does not seem to avoid the occurrence of ASD.