Frontiers in surgery · 2026
Rheumatoid arthritis and risks of postoperative adverse events after posterior lumbar interbody fusion for lumbar degenerative diseases: a retrospective cohort study with matched controls.
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Guo Zhiyuan, Liang Xiao, Liu Qingtao, Yang Puxin, Huo Yachong, Xu Jiaxin, Wang Hui, Meng Xianzhong
Аннотация
OBJECTIVE: To explore the correlation between rheumatoid arthritis (RA) and postoperative complications, long-term pain relief and functional recovery in patients undergoing posterior lumbar interbody fusion (PLIF) for lumbar degenerative diseases.
METHODS: A single-center 1:3 matched retrospective cohort study was conducted. From January 2015 to September 2020, 32 PLIF patients with confirmed RA were included in the exposed group, and 96 non-RA (NRA) PLIF patients were matched by age, gender, body mass index and single/double fusion segment. Binary logistic regression was performed to identify independent risk factors for complications, and unadjusted odds ratios (OR), relative risks (RR) with 95% confidence interval were calculated for each adverse event. All patients completed ≥2-year clinical and imaging follow-up.
RESULTS: All patients acquired immediate short-term postoperative pain reduction; however, RA group exhibited progressive recurrent back and leg pain during long-term follow-up. The postoperative and final follow-up visual analog scale for back and leg pain were significantly higher in the RA group than in the NRA group (P < 0.05), and the Oswestry Disability Index score at the last follow-up was also poorer (vs. NRA, P < 0.05). The postoperative C reactive protein level was markedly elevated in RA patients (vs. NRA, P < 0.05). RA group presented lower L1 Hounsfield Unit (HU) values and a higher incidence of osteoporosis (25.0% vs. 9.38%, vs. NRA, P < 0.05). Univariate analysis with unadjusted OR/RR demonstrated that RA was significantly associated with higher crude risks of total complications, wound infection, ASD and revision surgery.
CONCLUSION: RA is correlated with significantly elevated risks of multiple adverse events following PLIF for lumbar degenerative diseases.
METHODS: A single-center 1:3 matched retrospective cohort study was conducted. From January 2015 to September 2020, 32 PLIF patients with confirmed RA were included in the exposed group, and 96 non-RA (NRA) PLIF patients were matched by age, gender, body mass index and single/double fusion segment. Binary logistic regression was performed to identify independent risk factors for complications, and unadjusted odds ratios (OR), relative risks (RR) with 95% confidence interval were calculated for each adverse event. All patients completed ≥2-year clinical and imaging follow-up.
RESULTS: All patients acquired immediate short-term postoperative pain reduction; however, RA group exhibited progressive recurrent back and leg pain during long-term follow-up. The postoperative and final follow-up visual analog scale for back and leg pain were significantly higher in the RA group than in the NRA group (P < 0.05), and the Oswestry Disability Index score at the last follow-up was also poorer (vs. NRA, P < 0.05). The postoperative C reactive protein level was markedly elevated in RA patients (vs. NRA, P < 0.05). RA group presented lower L1 Hounsfield Unit (HU) values and a higher incidence of osteoporosis (25.0% vs. 9.38%, vs. NRA, P < 0.05). Univariate analysis with unadjusted OR/RR demonstrated that RA was significantly associated with higher crude risks of total complications, wound infection, ASD and revision surgery.
CONCLUSION: RA is correlated with significantly elevated risks of multiple adverse events following PLIF for lumbar degenerative diseases.