Introduction: Patients with rheumatologic disorders are similarly susceptible to degenerative spine disease to the general population. However, the treatment of such disorders with disease modifying antirheumatic drugs (DMARDs) may modify the morbidity profile of spinal surgery. The primary objective of this study is to characterize the association between DMARD use and short-term spinal surgeries outcomes.
Methods: This retrospective chart review included patients from 2011-2024 who underwent spinal surgery while on DMARDs. Data points collected include patient demographics, type of surgery, DMARD taken, and perioperative complications. Primary outcomes were length of stay (LOS), readmission and reoperations within the first 90 days, wound revision, and mortality within the first 90 days.
Results: 32 patients were included, 24 (75%) were female. The mean age of the cohort was 66.3 years and mean BMI was 29.24 kg/m^2. All included patients were Caucasian/white. 4 of the included patients were current smokers, 14 former smokers, 14 never smokers. The mean number of DMARDs each patient was on was 1.22. The most common DMARDs taken were hydroxychloroquine (16), methotrexate (10), and leflunomide (4). Surgical profile of the group included anterior cervical discectomy/fusion (5), minimally invasive (MIS) lumbar fusion (7), open lumbar fusion (13), lumbar decompression (5), posterior cervical fusion (1), and laminoplasty (1). Four (12.5%) patients had wound complications–2 required clinic/bedside wound revisions, while 2 required revision surgery for wound dehiscence. 75% of patients who required wound revisions were on hydroxychloroquine.
Conclusion : Patients who underwent elective spine surgery while on DMARDs are at increased risk of wound complications compared to other patient cohorts. While data is limited by small sample size, a majority of patients who experienced wound complications after their spinal surgery were on hydroxychloroquine. Special attention should be paid to patient selection and perioperative cessation of DMARDs in patients with rheumatic disease who undergo elective spinal surgery.
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