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.

Keywords: Hemodialysis; spondyloarthropathy; surgical management..

Fig. (1)

Lateral cervical spine extension X-Ray showing spondyloarthropathy with vertebral body degeneration, C3-C4 and C4-C5 instability and spurs.

Fig. (2)

Lateral cervical spine flexion X-Ray showing spondyloarthropathy with vertebral body degeneration, C3-C4 and C4-C5 instability and spurs.

Fig. (3)

Cervical spine MRI demonstrating spinal cord impingement at the C3-C4 level. Red arrows show the point of cord impingement.

Fig. (4)

Lateral cervical spine X-Ray showing anterior cervical discectomy and fusion at C3-C4, C4-C5 using PEEK allograft, and anterior fixation with dynamic plate and screws from C3 to C5.

Fig. (5)

Lateral cervical spine flexion X-Ray, which, in conjunction with extension X-Ray (Fig. 6) reveals hardware failure with cervical spine instability.

Fig. (6)

Lateral cervical spine extension X-Ray, which, in conjunction with flexion X-Ray (Fig. 5) reveals hardware failure with cervical spine instability.

Fig. (7)

Lateral cervical spine X-Ray showing posterior craniocervical stabilization and fusion with occipital and lateral mass screws, rods and allograft.

Fig. (8)

Cervical spine lateral X-Ray showing partial destruction of the C3 and extensive destruction of the C4 and C5 vertebral bodies.

Fig. (9)

Computed Tomography of the cervical spine, showing partial destruction of the C3 and extensive destruction of the C4 and C5 vertebral bodies.

Fig. (10)

Lateral cervical spine X-Ray showing anterior corpectomies and fusion using autograft and dynamic plate and screws from C3 to C6.

Fig. (11)

Postoperative cervical spine CT showing hardware failure at C3 with anterior shift of the allograft.

Fig. (12)

Lateral cervical spine X-Ray showing revision of the anterior fusion with replacement of displaced screws, and posterior fusion with screws, rods and allograft from C3 to C7.