Destructive spondylo-arthropathy during long-term haemodialysis

Naito, Masatoshi; Ogata, Katsuya; Nakamoto, Masahiko; Goya, Tadanobu; Sugioka, Yôichi

doi:10.1302/0301-620x.74b5.1527113

Cited by 32 publications

(22 citation statements)

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“…Consequently, a high postoperative mortality rate has been reported in these patients. 7,13 Although the numbers of patients in this study overall are small because of the high mortality rate, there are some important clinical topics to discuss. In Table 1 Summary of 15 patients who underwent surgery for cervical spine disorders.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

Sudo

Ito

Abumi

et al. 2006

SPI

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Object As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. Methods Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. Conclusions Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

Sudo

Ito

Abumi

et al. 2006

SPI

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“…Destructive change in the level adjacent to the vertebral ankylosis may progress more rapidly in DSA patients than in other patients as the effect of cervical DSA is usually seen at multiple levels. 6,12 Another problem is that the bony spinal canal at the C3-C4 to C6-C7 levels is narrower than the spinal cord, whereas it is much wider at the C2-C3 and C7-T1 levels. Surgery over a long span is therefore necessary for cervical DSA accompanied by severe multisegmental instability and was most often performed at the C3-C7 levels.…”

Section: Discussionmentioning

confidence: 99%

“…5,9,10 In addition, some cases of fatal DSA have recently been reported. 2,[8][9][10][11][12] No specific medical therapy has been found that can alter the progression or course of DRA, so that renal transplantation remains the best treatment modality for DRA. 13 For patients undergoing HD who are not candidates for renal transplantation, such as those with cervical DSA caused by neurologic symptoms, surgical treatment may be worth considering.…”

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confidence: 99%

Surgical Treatment with Instrumentation for Severely Destructive Spondyloarthropathy of Cervical Spine

Kamimura¹,

Nakagawa²,

Kinoshita³

et al. 2005

Journal of Spinal Disorders &Amp; Techniques

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Nine patients with severely destructive spondyloarthropathy and marked neurologic deficits associated with dialysis-related amyloidosis underwent posterior decompression and fusion by means of instrumentation at our institute. All patients showed segmental kyphosis, six patients vertebral ankylosis, and eight patients spondylolisthesis. Spondylolisthesis at two levels was noted in three patients. Of the 11 levels of spondylolisthesis in all, 9 were proximally adjacent and 2 were distally adjacent to vertebral ankylosis. All patients underwent posterior decompression and multisegment fusion with autogenous iliac bone. From three to five spinal segments were fixed. Seven patients underwent posterior fusion by means of a pedicle or lateral mass screw between levels C3 and C7, one patient between C3 and C6, and one between C3 and T1. The clinical rate of improvement at the final follow-up was 74.3%. Though complete stability could not be achieved in three patients, the results were rated as good. No postoperative neurologic deterioration has been observed in this series, nor did any patients die immediately after surgery or during the postoperative follow-up period. As anterior long-span surgery might be too invasive for hemodialysis patients, we think that posterior decompression and fusion may well be a reasonable and effective strategy for severe hemodialysis-associated cervical spondyloarthropathy with neurologic deficits. To achieve complete stability, 360 degrees fusion with both anterior and posterior fixation with instrumentation may be required for these patients.

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“…Itoh et al performed surgery for 17 patients with DSA and 1 patient died during the operation and 2 patients died perioperative period (15). Naito et al studied the outcome of 9 patients who had surgery for DSA and concluded that 5 patients had good, 2 patients had fair and 1 patient had poor results (18). They also reported that 1 patient died 46 days after the surgery due to postoperative meningitis.…”

Section: The Journal Of Medical Investigation Vol 64 February 2017mentioning

confidence: 99%

Radiographic changes of cervical destructive spondyloarthropathy in long-term hemodialysis patients: A 9-year longitudinal observational study

et al. 2017

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: Analyses of radiographic changes and clinical symptom of destructive spondyloarthropathy (DSA) on consecutive 42 patients managed with long-term hemodialysis were performed to elucidate radiographic changes of DSA and the factors that influence to the destructive changes. Patients underwent plain radiographs of the cervical spine with 9 years interval. Grading of radiological feature from lateral view was classified into grade 0 to grade 3. Clinical symptom was evaluated using modified Japanese Orthopaedic Association scoring system for cervical myelopathy (mJOA score). Destructive changes were observed in 3 patients at the first examination, and those were observed in 15 patients 9 years after the first examination. There is no statistically significant difference between the duration of hemodialysis and the grade. The mean age at the onset of hemodialysis, however, was significantly higher in patients of grade 2 and 3 than those of grade 1. Older patients with long-term hemodialysis had destructive changes. Destructive changes commonly observed in lower cervical spine. The average numbers of the involved disc level were 1.6 in grade 2 and 1.0 in grade 3. Clinical symptoms were varied in each grade and there was no statistically significant difference in total mJOA score among these grades.

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Destructive spondylo-arthropathy during long-term haemodialysis

Cited by 32 publications

References 0 publications

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

Surgical Treatment with Instrumentation for Severely Destructive Spondyloarthropathy of Cervical Spine

Radiographic changes of cervical destructive spondyloarthropathy in long-term hemodialysis patients: A 9-year longitudinal observational study

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