Rheumatoid Arthritis Back Surgery

Rheumatoid Arthritis (RA) is not an age-related degenerative form of arthritis of the spine such as spondylosis, but can sometimes be treated through back surgery to relieve patients’ pain and discomfort.  This is particularly true of cervical rheumatoid arthritis where nerve problems in the neck may be caused by inflammation and changes in the structure of the joints.  Decompression back surgery, or cervical spinal surgery, may be able to relieve the pinched nerves and provide stability to the spine.  Although the usual perception of this condition is of patients having deformities in the hands and feet, Rheumatoid Arthritis of the spine is evident in around 20% of RA patients and can cause significant disability and pain.  Most patients will be given a treatment programme incorporating conservative therapies such as anti-inflammatory medications and analgesics, immuno-suppressant drugs, and physical therapy before surgery is considered for RA.

If, however, a patient with rheumatoid arthritis has pain which no longer responds to medication and is suffering neurological dysfunction, or if the cervical spine is unstable, weak, and is causing myelopathy, then it is likely that surgery is required.  Back surgery for rheumatoid arthritis aims to decompress the structures of the spine and remove the material causing pinched nerves or spinal cord compression; it also aims to restore or maintain spinal stability.   Where spinal deformity and instability are present, back surgery for rheumatoid arthritis will usually involve some element of spinal fusion using instrumentation and bone grafts.

Surgery for Rheumatoid Arthritis is more effective when done early on in the disease’s progression in order to decompress the back and remove material causing pinched nerves.  As the disease becomes more virulent the chances of back surgery easing a patient’s pain or relieving their condition become less likely with diseased joints and spinal structures often osteoporotic and degenerated beyond repair.  Back surgery at this stage may do more harm than good as surgical trauma can increase inflammation, raise stress levels, and affect the immune system in all patients, which can clearly have more damaging consequences for those with an inflammatory autoimmune disease such as Rheumatoid Arthritis.  Patients will usually be given more medication to help with pain management.  Treating Rheumatoid Arthritis effectively relies on catching the disease early and using appropriate therapies consistently to inhibit its progression.

As RA often appears between the ages of forty and sixty, when the signs of osteoarthritis might also develop, diagnosis is sometimes delayed and serious joint damage may occur prior to effective treatment being initiated.  Around 1% of the population is thought to have Rheumatoid Arthritis.  Symptoms to look out for include pain at the base of the skull, the neck and back, and problems with balance or irregular gait.  Some Rheumatoid Arthritis sufferers may experience blackouts as the cervical spine and blood vessels are compressed by abnormal growth and inflammation.  Neuropathy, with tingling in the arms and legs can also occur, and bowel or bladder incontinence indicates an urgent need for surgical intervention in some cases due to spinal cord compression.

Continued Reading: Rheumatoid Arthritis in the Cervical Spine