Spine Surgeries in Arthritis

Dr.Tushar Pisal

Spine surgeries in patients with arthritis are not very common. Uncontrollable pain is uncommon indication of spine surgery in case of arthritis. Instability of spine with neurological deficit is most common problem where we need surgery. Significant deformity can be the indication of surgery in condition like ankylosing spondylitis.

Rheumatoid arthritis - Neck is most common region which is involved in rheumatoid arthritis. Neck is dependent on ligaments and joint capsule for stabilization and it is most mobile area of spine. C1-C2 vertebrae are mostly involved in rheumatoid arthritis as it is stabilized by joint capsule and ligaments.

Most of the patients with cervical spine instability presents very late with neurological deficit. They need surgery in the form of decompression and stabilization. Prognosis of these patients is good. 

Some patients may just have compression on the spinal cord without instability, such patients can be managed with decompression of the spinal cord with stabilization using anterior or posterior approach.

Coming to Ankylosing spondylitis - Fortunately most of the patients with ankylosing spondylitis doesn't need surgery. Four indications of surgery

1.The spinal deformity is in a fixed flexed position. The magnitude (angle) of the deformity is the most important consideration. An example is forward flexion so great the chin rests near or on the chest (commonly called chin-on-chest deformity). The functional limitations of this particular deformity are great. In the example, the patient would be unable to look forward, make visual contact, drive.

When patient is not able to see in front, we need to do deformity correction by doing osteotomy at the level of lumbar spine as shown in picture.

2.The stability of the spine is compromised. An unstable spine means that it moves too much and the joints aren't controlling the spine mobility as they should. Spinal instability puts the patients more at risk for nerve damage.

3.Neurologic deficit exists. "Neurologic deficit" means a nerve problem that causes sensory (eg, pain, tingling sensations) and/or motor changes (eg, weakness).

4.Fracture - Fractures in ankylosing spondylitis are common due to stiff spine and osteoporosis. Fractures in ankylosing spondylitis are highly unstable and mostly associated with neurological deficit.

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