Surgical Treatment with Instrumentation for Severely Destructive Spondyloarthropathy of Cervical Spine

Abstract

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.

Surgical Management of Cervical Spondyloarthropathy in Hemodialysis Patients

“…Albumi et al believe that cervical spine DSA often requires circumferential reconstructive surgery, because affected patients typically have both the anterior columns and the facet joints compromised [4]. In contrast, Yuzawa et al suggest that anterior long-span surgery may be too invasive in hemodialysis patients, whereas posterior decompression and fusion may be a reasonable, effective strategy for severe hemodialysis-associated cervical spondyloarthropathy with neurologic deficits [8]. On the other hand, Nair et al reported two cases managed with anterior approach due to anterior compression, with one of the two requiring supplemental posterior fixation because of hardware failure and pseudarthrosis [9].…”

Perforation Rates of Cervical Pedicle Screw Inserted from C3 to C6 - A Retrospective Analysis of 78 Patients over a Period 5 of 14 Years -

“…In the meta-analysis reported by Tian et al, the accuracy of pedicle screw insertion by CT navigation (90.76%) was significantly improved compared to the two-dimensional imaging system (85.48%) [16]. Our institution employs a CT-based navigation system for the cervical pedicle screw insertion [9][10][11][12]. The result of this paper was that the percentage of major perforations were 4.4%, total perforation rates were 17.9% for all cervical pedicle screws.…”

“…However, cervical pedicle screw insertion is technically demanding because of the narrow pedicle diameter and the risk of serious neurovascular complications including vertebral artery tear, spinal cord injury, and nerve root injury [7]. To achieve more accurate and safe pedicle screw insertion, navigation by two-dimensional imaging system or CT has been employed in recent years [9][10][11][12]. However, CPS insertion from C3 to C6 is technically demanding.…”

Perforation Rates of Cervical Pedicle Screw Insertion by Disease and Vertebral Level

“…Among the previous reports of perforation rates of cervical pedicle screw by disease, the perforation rates for RA, DSA, and spinal trauma were 0-22% [9,10], 6.1% [11], and 3.9-9.2% [12], respectively. Insertion methods employed in these reports included CT-based navigation and twodimensional imaging systems.…”

“…A difference in CPS perforation rate according to bone quality or morphology of pedicle is to be expected; however, whether there are differences in CPS perforation rate due to variation in bone quality because of osteoporosis or osteosclerotic pedicle, or by morphology or size of pedicles, is not clearly understood. In addition, differences in CPS perforation rates according to disease may exist; however, although CPS perforation rates for rheumatoid arthritis (RA), DSA, and trauma treatment by various procedures have been *Address correspondence to this author at the Department of Orthopaedic Surgery, Shinshu University, School of Medicine, 3-1-1 Asahi, MatsumotoCity, Nagano, 390-8621, Japan; Tel: 81-263-37-2659; Fax: 81-263-35-8844; E-mail: jtaka@shinshu-u.ac.jp reported [8][9][10][11][12], there have been no reports on CPS perforation rates by disease. The purpose of this study is to evaluate the perforation rates of cervical pedicle screw insertion using CT-based navigation system by disease and vertebral level (from C2 to C7).…”