Question
I have undergone two fusion attempts for C1-C2 instability which have both failed. I am about to undergo a third attempt with screws and a cable instead of just wire. I know that I have to stop taking my methotrexate, but my question concerns whether I should stop taking my Enbrel for this procedure. I have one doctor saying yes and another saying no. Can you please help me with this confusion? I really want the fusion to work this time. My surgery is in a couple of weeks and I am not sure what to do.
Answer
Unfortunately there is very little information on TNF inhibitors and surgery. The obvious concern is whether there is an increased risk of perioperative infections with these drugs, or if these drugs delay healing. These concerns need to be balanced with stopping the drugs which can result in a flare of joint inflammation interfering with rehabilitation and delay healing in the joint not to mention the general discomfort of the patient.
There were similar concerns with methotrexate and although there may be differences in opinion, I stop methotrexate the week prior and then restart it 1-2 weeks post-op. I am doing the same with the TNF inhibitors Enbrel and Humira, but there are no good studies to prove me right or wrong.
