The Pitfalls in Surgical Management of Lumbar Canal Stenosis Associated With Rheumatoid Arthritis
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概要
- 論文の詳細を見る
There have been few clinical studies in the area of cervical spine that focused on surgery for treating degenerative lumbar disease in patients with rheumatoid arthritis (RA). High rates of wound complications and instrumentation failure have been reported more for RA than for non-RA patients, although clinical outcomes are similar between the two groups. Lumbar canal stenosis in RA is caused not only by degeneration but also by RA-related spondylitis, which includes facet arthritis and inflammation around the vertebral endplate. The pitfalls in surgical management of lumbar canal stenosis in RA patients are highlighted in this study. The study reviewed 12 patients with RA, who were surgically treated for lumbar canal stenosis. Two out of five patients with pulmonary fibrosis died of worsened pulmonary condition, even though there were no perioperative pulmonary complications. Two patients with pedicle screw fixation showed no instrumentation failure, but two patients with spinous process fixation needed re-operation or vertebral fracture. Surgical treatment for lumbar canal stenosis in RA patients needs to be individually adjusted. Preoperative assessments and treatments of pulmonary fibrosis and osteopenia are essential. Surgery for lumbar canal stenosis with RA should be deferred for patients with advanced pulmonary fibrosis because of its potential life-threatening risk. Fusion surgery is indicated only in patients with kyphosis or severe symptoms caused by intervertebral instability. Pedicle screw fixation with hydroxyapatite granules or sublaminar tape is recommended. Closer follow-up after surgery is necessary because of possible delayed wound infection, instrumentation failure, pathological fracture, and respiratory deterioration.
- 社団法人 日本脳神経外科学会の論文
著者
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Mizuno Masaki
Department Of Cardiovascular Dynamics National Cardiovascular Centre Research Institute
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Ando Ryo
Department Of Electrical And Computer Engineering Faculty Of Technology Kanazawa University
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HASHIMOTO Ryo
Department of Cardiovascular Medicine, Yamaguchi University Graduate School of Medicine
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Okada Yoshikazu
Department Of Medical Informatics Tokai University School Of Medicine
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Kubota Motoo
Department Of Neurological Surgery Chiba University School Of Medicine
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Mitsuyama Tetsuryu
Department Of Neurosurgery Tokyo Women's Medical University Daini Hospital
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OKADA Yoshikazu
Department of Neurosurgery, Tokyo Women's Medical University
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MIZUNO Masaki
Department of Spinal Surgery, Kameda Medical Center
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YUZURIHARA Masahito
Department of Spinal Surgery, Kameda Medical Center
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ANDO Ryo
Department of Spinal Surgery, Kameda Medical Center
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MITSUYAMA Tetsuryu
Department of Neurosurgery, Tokyo Women's Medical University
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KUBOTA Motoo
Department of Spinal Surgery, Kameda Medical Center
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