Two Cases of Lumbar Destructive Lesions in Rheumatoid Arthritis

• Published in: Japanese Journal of Rheumatism and Joint Surgery Vol. 16; no. 1; pp. 63 - 72
• Main Author: HINOHARA, Shinichi
• Format: Journal Article
• Language: English; Japanese
• Published: Japanese Society for Joint Diseases 1997; 日本関節病学会
• Subjects: destructive change; lumber spine; rheumatoid arthritis; surgical treatment
• ISSN: 0287-3214; 1884-9059
• DOI: 10.11551/jsjd1982.16.63

We report 2 cases of lumbar destructive lesions in patients with rheumatoid arthritis (RA) . A 56-year-old woman with a 14-year history of RA experienced increasing backache over a six-month period. Plain rentogenograms of the lumbar spine showed destructive changes of the vertebral end-plates and facet joints at the L3 and L4 levels, and a lateral slip of L3. Patient underwent anterior lumbar interbody fusion. Histological findings showed nonspecific chroni'c inflammation with granulation and fibrinoid necrosis. Six weeks later, grafted bone was displaced. However, 14 weeks after surgery anterior fusion was achieved, relieving the patient of symptoms. The second case was a 57-year-old woman with a 10-year history of RA who experienced increasing backache and leg pain over a six-month period. Plain rentogenograms showed destructive changes of the vertebral end-plates and facet joints at the L4 and L5 levels, and a lateral slip of L4. Patient underwent a decompressive lumbar laminectomy and a posterior stabi-lization with the ISOLA system, and simultaneous anterior fusion. Histological findings showed synovial proliferation in L4/5 facet joints, but specific inflammation for RA was not found in the vertebrae and intervertebral disc. The patient was relieved of symptoms. We believe that posterior stabilization with instruments is desirable for maintaining good alignment when there are severe destructive changes in facet joints in RA spondylitis.