Rheumatoid arthritis-associated spinal neuroarthropathy with double-level isthmic spondylolisthesis

Abstract

A RA patient with double-level isthmic spondylolisthesis showed a progressive destructive lesion. In addition to clinical presentations, the imaging findings were very similar to ones of spinal neuroarthropathy. The authors conclude that this Grand Round case probably had SNA secondary to RA and that this, combined with two-level isthmic spondylolisthesis, resulted in her rapidly progressing destructive lumbar lesion.

Factors influencing spinal sagittal balance, bone mineral density, and Oswestry Disability Index outcome measures in patients with rheumatoid arthritis

“…Regarding VD, Sakai et al revealed that the Lansbury Index and Ochi's classification, which are both scales of disease activity, reflected the severity of lumbar changes on X-ray and MRI changes [42]. In addition, Kim et al reported a case of 56-year-old RA patient who presented with a rapidly progressive double-level isthmic spondylolisthesis at L4/5 and L5/S; this pathology is similar to that of spinal neuropathy [43]. Therefore, it is possible that RA itself may cause vertebral deformity or instability and lead to larger SVA.…”

Surgical Management of the Lumbar Spine in Rheumatoid Arthritis

“… 26 - 28 There have also been case reports of spinal neuroarthropathy secondary to RA, caused by loss of innervation to the spine from cytokine release leading to degenerations in disks, end plates, and facet joints resulting in dislocations. 29 …”