Vol. 7, Issue 1, Part A (2025)

Objective: To systematically evaluate the impact of rheumatoid arthritis (RA) on implant-related complications and reoperation rates in patients undergoing spinal surgery.

Methods: This systematic review followed the PRISMA guidelines and was registered on PROSPERO. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library was conducted. Inclusion criteria encompassed observational studies comparing outcomes in adult RA patients and non-RA controls undergoing cervical, thoracic, or lumbar spine surgery. Data were extracted on surgical region, technique, complications, infections, and reoperation rates. Risk of bias was assessed using the Newcastle-Ottawa Scale.

Results: Twelve comparative studies comprising over 60,000 patients were included. RA patients consistently exhibited higher rates of implant-related complications such as screw loosening, pseudarthrosis, and cage migration. They also had significantly increased rates of adjacent segment disease (ASD), surgical site infections, and reoperations. Factors contributing to these outcomes included poor bone quality, immunosuppression, and anatomical challenges. Cervical procedures were particularly impacted by vertebral artery anomalies and narrow pedicles, while lumbar fusions were associated with greater hidden blood loss and higher revision rates. RA patients also demonstrated more comorbidities, including osteoporosis, anemia, and cardiovascular disease, which may further increase perioperative risk.

Conclusion: Rheumatoid arthritis is an independent risk factor for complications and surgical failure in spine surgery. Recognition of these risks should guide preoperative optimization, surgical planning, and postoperative care. A multidisciplinary approach is essential to improving outcomes in this high-risk population.