Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

Abstract

Study designCase-series study.ObjectiveTo describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis.BackgroundLumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports.MethodsSix patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed.ResultsThe affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients.ConclusionsLumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.

The Pitfalls in Surgical Management of Lumbar Canal Stenosis Associated With Rheumatoid Arthritis

“… 13 , 23) Compared with the attention paid to cervical lesions, there have been relatively few systematic reports on the surgical treatment of lumbar lesions in patients with RA. 3 , 11 , 16) Several reports have described that a significant number of patients with RA have abnormal radiological findings in the lumbar spine, and some of them reported that the incidence in patients with RA is higher compared to that observed in patients without RA. 6 , 13 , 23) On the other hand, Harzy et al described radiological lumbar lesions, expect for vertebral fracture, were not more frequent among RA patients than among control populations.…”

“…Two major sites of pathology in RA-associated lumbar lesions are facet joints and vertebral endplates. 2 , 3 , 7 , 13 , 14 , 16 , 19 , 23 , 25) Facet joints, also known as apophyseal joints, are synovial joints as well as peripheral joints. 29) Synovitis probably starts in facet joints with erosion of cartilage and subchondral bone in exactly the same fashion as seen in peripheral joints.…”

“… 29) Synovitis probably starts in facet joints with erosion of cartilage and subchondral bone in exactly the same fashion as seen in peripheral joints. 3 , 7 , 13 , 16) Chronic facet arthritis leads to erosion of facet joints, which causes, or enhances, intervertebral instability. In the present study, we observed distinct erosion of facet joints in the CT scans of four patients (25%), which is in agreement with the findings of Kawaguchi et al, who reported an affect rate of 20% in RApatients.…”

“… 13) Another lesion probably starts at the discovertebral junction as an enthesopathy with chronic inflammation around the vertebral end plates, leading to spondylodiscitis. 2 , 3 , 7 , 13 , 14 , 16 , 17 , 19 , 23 , 25) The endplate consists of hyaline cartilage in which Type II collagen is predominant, and its biochemical structure is similar to that of the synovial joint. 9) This inflammation at endplate leads to structural destruction of discovertebral junction, which causes or enhances disc wedging, intervertebral instability, and lumbar deformity.…”

“… 2 , 3 , 7 , 13 , 14 , 16 , 19 , 23 , 25) Compared with the attention paid to the cervical lesions, there have been relatively few reports in English about surgical treatment for degenerative lumbar lesions with RA. 3 , 11 , 16) Surgery for lumbar canal stenosis relieves leg pain and neurogenic claudication adequately in RA as well as non-RA patients. However, the rate of perioperative complications, such as wound infection or instrumentation failure, has been reported more often in RA patients than in non-RA patients.…”