Surgical Correction of Severe Lumbar Spine Instability and Sagittal Deformity in a Patient with Rheumatoid Arthritis Without the Utilization of an Osteotomy

Abstract

Purpose: Complications from RA can involve the thoracolumbar spine and cause severe spine instability and sagittal deformity. We present a surgical strategy to restore sagittal balance in a patient with chronic rheumatoid arthritis. Methods: A retrospective chart review was performed. Results: We report the case of a 53-year-old woman with RA and severe back pain. She had dynamic instability of her lumbar spine with spondylolithesis at L3-L4 and L4-L5 as well as hypermobility at the C1-2 level without rheumatoid pannus. On 36-inch standing films, she had a sagittal vertical axis (SVA) of 219 mm. She underwent anterior and posterior instrumented fusion to restore her sagittal imbalance, which resulted in excellent relief of her back pain and marked improvement in ambulation and function. Conclusion: Patients with RA can develop severe sagittal deformity that could be the source of back pain. In patients with advanced RA, chronic inflammation could lead to ligament laxity that can result in spinal deformity under axial load. This deformity is amenable to reconstruction without the utilization of an osteotomy, which can produce excellent pain relief and restoration of function.