Surgery for Rheumatoid Arthritis

When may surgery be necessary?
In some patients, surgery may be an option to treat cervical rheumatoid arthritis (RA). Surgery is usually recommended for patients who have nerve problems caused by the effects of RA. For example, inflammation and changes in the joints can affect the surrounding nerves.

Certain surgical procedures decompress (remove pressure from) the spinal cord and provide spinal stabilization. You may need to have surgery if you have:

• uncontrollable pain combined with neurologic dysfunction
• myelopathy from cervical spine instability
• severe weakness resulting in functional disability

Procedures
Different surgical procedures are used to decompress the spinal cord. The goal in this surgery is to remove the offending tissue pressing on the spinal cord or nerves. The surgeon will make recommendations based on many variables, including the specifics of your condition.

Spinal instrumentation and fusion are surgical procedures that may be used to correct spinal deformity and to provide permanent stability to the spinal column. These procedures join and solidify the level where a spinal element has been damaged or removed.

Instrumentation utilizes medically-designed hardware such as rods, bars, wires, and screws. These devices hold the spine straight during fusion. Fusion is the adhesive process that joins bony spinal elements.

In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth). The fusion will stop movement between the vertebrae, providing long-term stability.

Recovery from Spine Surgery for RA
Living with rheumatoid arthritis involves learning to adapt and making lifestyle changes that include a good diet, exercise, and rest. Here are some ways to deal with RA:

• A physical therapy (PT) program can help restore muscle strength, flexibility, improve mobility, coordination, and maintain body functions through exercise. Massage, hydrotherapy, and other modalities can relieve pain. Gait training and use of assisted devices (e.g. cane, walker) can be taught to patients with difficulty walking.
  
• Occupational therapy (OT) teaches the patient how to cope with everyday life. OT encourages independence by helping the patient with daily tasks such as dressing, bathing, food preparation, going to the toilet, and other activities of daily living (ADLs).
  
• A personal medical diary can help keep track of doctor appointments, medications taken on a daily basis including supplements (vitamins, herbs), drugs that alleviated symptoms, side effects, flare-ups, and remissions.

It is important to keep follow-up appointments with your doctor. Monitoring rheumatoid arthritis may include periodic blood tests, assessment of functional ability, pain status, and x-rays to evaluate possible disease progression.