Surgical Management of Cervical Spondyloarthropathy in Hemodialysis Patients

Abstract

Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy. Optimal management of cervical spine spondyloarthropathy often requires circumferential reconstructive surgery, because affected patients typically have both the anterior column and the facet joints compromised. The occasional presence of noncontiguous or "skip lesions" adds an additional level of complexity to surgical management, because decompression and fusion in an isolated segment of neural compression can worsen spine deformity by applying increased stress to adjacent cervical spine segments. We report two cases of hemodialysis patients who presented with cervical myelopathy and initially had anterior cervical discectomy or corpectomy. Because symptoms recurred due to hardware failure, both patients required posterior spine fusion as well. In retrospect, because of the hardware failure, both of these patients might have benefited from a circumferential (combined anterior and posterior) cervical spine reconstruction as their initial treatment.

Complex Revision Surgery for Cervical Deformity or Implant Failure

“…There have been many reports of hardware failure and the need for revision surgery after anterior corpectomy or discectomy and fusion due to fragility of the bones in dialysis patients. [45][46][47] In addition, invasive surgical procedures might increase the risk of postoperative complications and mortality in patients on longterm hemodialysis who have multiple comorbidities and poor health condition. Chikuda et al 48 reported that dialysis-depen-dent patients had a 10-fold higher risk of in-hospital mortality.…”

Cervical Myelopathy

“…We can regroup rare neurologic complications which can cause narrowing of the cervical canal such ankylosing spondylitis, gouty tophi from the posterior joints and vertebral ankylosing hyperostosis (Forestier's disease) or Paget's disease. Myelopathies have been observed in patients on long-term dialysis due to epidural calcification (85). ++++…”

Surgical Outcome for Hemodialysis-Related Upper Cervical Lesions

“…The cervical spine is the most common site for hemodialysis-related lesions, and cervical DSA severely restricts the activities of daily living for hemodialysis patients. Several reports have described the surgical outcome and long-term follow-up results for hemodialysis patients with lower cervical lesions [ 2 3 4 5 6 ]. Other reports have described upper cervical lesions in patients receiving long-term hemodialysis [ 7 8 9 10 11 12 13 14 15 16 ].…”