Postoperative outcomes after cervical spine surgery in rheumatoid arthritis patients: a multicenter cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: There is a lack of comparative studies examining patient-reported outcomes (PROs) after cervical spine surgery between rheumatoid arthritis (RA) and non-RA patients. The objective of this study was to compare postoperative outcomes after cervical spine surgery between RA and non-RA patients. Methods: This retrospective cohort study utilized prospectively registered data from patients older than 18 years who underwent primary cervical spine surgery from April 2017 to March 2022 at 13 institutions in the Greater Tokyo metropolitan area. Demographics, perioperative complications, surgical details, and PROs were recorded. Propensity-score overlap weighting was used to adjust for baseline and surgical differences between RA and non-RA groups, and group differences were reported with 95% confidence intervals. Results: In this cohort of 2,729 participants, 2.5% (67 individuals) were diagnosed with RA. These RA patients were predominantly older women with lower body mass index and more frequently required upper cervical or fusion surgery. The average duration of RA was 21 years, with treatment involving steroids in 56.7%, methotrexate in 41.8%, and biologics in 19.4%. After overlap weighting, RA patients had poorer preoperative and postoperative PROs than non-RA patients. However, RA patients showed improvements in several symptoms and quality-of-life measures. The overlap-weighted improvement in EQ-5D was 0.14 in RA patients and 0.13 in non-RA patients [difference, 0.01; 95% confidence interval (CI): -0.06 to 0.09]. The Neck Disability Index (NDI) showed only limited improvement in RA patients, whereas postoperative satisfaction was not clearly lower in RA patients. Conclusions: Patients with RA had poorer PROs before and after cervical spine surgery than non-RA patients. Nevertheless, selected RA patients showed improvement in several symptoms and quality-of-life measures, and postoperative satisfaction was not clearly lower. Disability measured by the NDI may remain less responsive, and the limited number of RA patients and wide confidence intervals preclude any conclusion of equivalence with non-RA patients.
Source: Journal of Spine Surgery
Authors: Yasushi Oshima, Hiroyasu Kodama, Yudai Kumanomido, Michita Noma, Yuko Yagi, Naohiro Kawamura, Yukimasa Yamato, Tomomi Sunayama, Akiro Higashikawa, Naoto Komatsu, Nobuhiro Hara, Takashi Ono, Ryoko Onodera, Yujiro Takeshita, Masayoshi Fukushima, Naoki Okamoto, Katsuyuki Sasaki, Yuichi Yoshida, So Kato, Yuki Taniguchi, Sakae Tanaka
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223366525