Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

Uehara, Mariko; Takahashi, J.; Hirabayashi, Hiroki; Ogihara, Nobuhide; Mukaiyama, Keijiro; Kuraishi, Shugo; Shimizu, Masayuki; Hashidate, Hiroyuki; Kato, Hiroyuki

doi:10.1016/j.spinee.2012.11.012

Cited by 11 publications

(5 citation statements)

References 29 publications

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“…After full-text scrutiny with inclusion and exclusion criteria, 37 studies were selected for qualitative synthesis. [22][23][24] As 4 studies did not provide SDs for EQ-5D scores 43,44,64,67 and 2 studies did not provide the EQ-5D score, 46,66 the meta-analysis was performed with 31 studies. The selection of studies is described in the PRISMA flowchart (Figure 1) and characteristics of included studies is tabulated in Table 1.…”

Section: Re Sultsmentioning

confidence: 99%

Health‐related quality of life in rheumatoid arthritis: Systematic review and meta‐analysis of EuroQoL (EQ‐5D) utility scores from Asia

2021

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Introduction Region‐specific health‐related quality of life (HRQoL) scores or utility values are representative and pivotal for economic evaluations as they are influenced by the value judgment of the local population. This study systematically reviewed and pooled EuroQoL‐5 Dimension (EQ‐5D) utility scores of rheumatoid arthritis (RA) across primary studies from Asia. Methods Studies reporting EQ‐5D utility scores among adult RA patients from Asian countries were systematically searched in PubMed‐Medline, Scopus and Embase since inception through February 2020. Selected studies were systematically reviewed and study quality assessment was performed. Meta‐analysis was performed using a random‐effect model with subgroup and meta‐regression analysis to explore heterogeneity. Results Among 1391 searched articles, 37 studies with 31 983 participants were systematically reviewed and meta‐analysis was conducted among 31 studies. The pooled EQ‐5D scores and EQ‐5D visual analog score were 0.66 (95% CI 0.63‐0.69, I2 = 99.65%) and 61.21 (50.73‐71.69, I2 = 99.56%) respectively with high heterogeneity. For RA patients with no, low, moderate and high disease activity based on Disease Activity Score (DAS)‐28, the pooled EQ‐5D scores were 0.78 (0.65‐0.90), 0.73 (0.65‐0.80), 0.53 (0.32‐ 0.74), and 0.47 (0.32‐0.62), respectively. On meta‐regression, age of patients (P < .05) was positively associated and use of glucocorticoids (P < .05) was inversely associated with utility values. Conclusion Lower EQ‐5D scores were associated with severe disease activity, increasing age and female gender among RA patients. The study provides pooled EQ‐5D scores for RA patients that are useful inputs for cost‐utility studies in Asia.

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Section: Re Sultsmentioning

confidence: 99%

Health‐related quality of life in rheumatoid arthritis: Systematic review and meta‐analysis of EuroQoL (EQ‐5D) utility scores from Asia

2021

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“…Previous studies have investigated outcomes of performing cervical spine fusions on the upper cervical spine on patients with RA. These have demonstrated that there are clear quality of life improvements seen with these procedures,[ 15 ] and outcomes depend on severity of condition at initial presentation. [ 10 ] Patients with less preoperative impairment generally have better surgical outcomes,[ 27 ] thus intervening early and before BI occurs has been shown to reduce the risk of complications and increase long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…[ 6 10 ] Surgical reconstruction has been demonstrated to improve patients’ health-related quality of life, but how these medications may affect outcomes has not been investigated. [ 15 ] Our study aims to be the first to investigate how RA medications including corticosteroids, methotrexate, and biologics may affect clinical and radiological outcomes following fusions at the CVJ in the rheumatoid spine.…”

Section: Introductionmentioning

confidence: 99%

The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction

Khanna

Dlouhy

Smith

et al. 2015

J Craniovert Jun Spine

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Objective:Rheumatoid arthritis (RA) is an inflammatory disease that affects the craniovertebral junction (CVJ). Patients may suffer from atlantoaxial instability (AAI) and basilar invagination (BI) with variable presentations ranging from pain to quadriparesis. Managing these patients is often challenging due to their chronic use of steroids, methotrexate, and biologics; which impedes bone and wound healing. We report our experience with the surgical management of these patients undergoing fusions at the CVJ.Materials and Methods:We conducted a retrospective study identifying all patients with the diagnosis of RA who underwent spinal fusions at our institution over the past 11 years. A total of 205 patients were identified amongst which 18 patients (8.8%) who underwent 20 fusions involving the CVJ. Demographic, clinical, and radiographic data were analyzed.Results:Five patients had AAI and 13 patients had BI. Two patients with C1-2 fusions underwent reoperation: One for pseudoarthrosis and one for BI. The average preoperative Nurick was 1.4 and improved to 0.5 postoperatively (P < 0.001). After conducting analyses stratified by dichotomous preoperative variables, the presence of steroids, methotrexate, biologics, and prednisone dosage less than 7.5 mg did not affect outcomes. Prednisone dosages ≥7.5 mg had significantly smaller improvements in Nurick score compared to patients not on steroids or on prednisone dosages <7.5 mg (0.40 vs 1.36, P = 0.042). Similarly, patients on biologics had significantly smaller improvements in Nurick score compared to patients not on biologics (0.27 vs 1.16, P = 0.038).Conclusion:Fusions at the CVJ in patients with RA on daily prednisone dosages of less than 7.5 mg and/or methotrexate can be performed safely with good outcomes, fusion rates, and acceptable complication profiles. Daily prednisone dosages of more than 7.5 mg or biologics may impact clinical outcomes.

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“…The mean score for this group was 21.0 (SD, 12.9), which is considered by the original authors to be in the ''moderate disability'' category [15][16][17][18][19][20][21][22][23][24]. Because this is a diseasespecific outcome measure, there is no general population standard.…”

Section: Comparisons With Other Populationsmentioning

confidence: 99%

“…Our understanding of patient QOL after spine surgery is improving [14][15][16][17][18][19][20][21][22][23][24][25], but relatively little has been published on QOL after en bloc resection of spine tumors [26][27][28]. In this study, we seek to augment the current understanding of QOL after en bloc resection of malignant spine tumors by comparing our en bloc surgery group with an internal control group who had similar disease and comorbidity status but received definitive radiation alone without major surgery.…”

Section: Introductionmentioning

confidence: 99%

Quality of life after en bloc resection of tumors in the mobile spine

et al. 2015

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Evaluation of clinical results and quality of life after surgical reconstruction for rheumatoid cervical spine

Abstract: Background Context: The EuroQol (EQ-5D) is a widely used comprehensive measure

Cited by 11 publications

References 29 publications

Health‐related quality of life in rheumatoid arthritis: Systematic review and meta‐analysis of EuroQoL (EQ‐5D) utility scores from Asia

Health‐related quality of life in rheumatoid arthritis: Systematic review and meta‐analysis of EuroQoL (EQ‐5D) utility scores from Asia

The impact of steroids, methotrexate, and biologics on clinical and radiographic outcomes in patients with rheumatoid arthritis undergoing fusions at the craniovertebral junction

Quality of life after en bloc resection of tumors in the mobile spine

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