Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;9(5):699-704.
doi: 10.4184/asj.2015.9.5.699. Epub 2015 Sep 22.

Surgical Outcome for Hemodialysis-Related Upper Cervical Lesions

Keiji Wada  1 , Yasuaki Murata  1 , Yoshiharu Kato  1
Affiliations

Surgical Outcome for Hemodialysis-Related Upper Cervical Lesions

Keiji Wada et al. Asian Spine J. 2015 Oct.

Abstract

Study design: A retrospective study.

Purpose: To investigate the surgical outcome for hemodialysis-related upper cervical lesions.

Overview of literature: Surgical outcome of lower cervical lesions in patients undergoing hemodialysis has been reported. However, surgical outcome for upper cervical lesions in hemodialysis patients is unclear.

Methods: Upper cervical lesions in nine patients undergoing hemodialysis were surgically treated. Mean age at surgery was 61.6 years (range, 52-68 years), and the mean follow-up period was 45.4 months (range, 2-98 months). Patients had undergone hemodialysis for an average of 25.3 years (range, 16-40 years) at surgery. Seven patients with destructive spondyloarthropathy (DSA) of the upper cervical spine were treated with atlantoaxial or occipitocervical fixation. Two patients with retro-odontoid pseudotumors were treated with C1 posterior arch resection alone. Japanese Orthopedic Association (JOA) scores for cervical myelopathy, postoperative complications, postoperative radiography, and preoperative and postoperative occipital pain were evaluated.

Results: Mean preoperative and postoperative JOA score was 3.7 and 8.1, respectively. The seven patients with DSA had severe preoperative occipital pain that disappeared postoperatively. Postoperative radiography showed solid bone union in DSA cases and no instability in pseudotumor cases.

Conclusions: Satisfactory surgical outcome was observed for hemodialysis-related upper cervical lesions.

Keywords: Destructive spondyloarthropathy; Hemodialysis; Surgical outcome; Upper cervical spine.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Preoperative extension (A) and flexion (B) lateral radiographs showing severe instability of atlantoaxial joints.
Fig. 2
Fig. 2. Sagittal computed tomography (CT) showing mild destruction of right Oc-C1 joint (A) and mild destruction of left Oc-C1 joint and severe destruction of left atlantoaxial joint (B). (C) Sagittal CT showing erosive change of the odontoid process. Oc, occiput.
Fig. 3
Fig. 3. Magnetic resonance imaging showing T2 high signal in spinal cord at C1 level without sever spinal canal stenosis, indicating spinal cord injury due to instability of atlantoaxial joints (arrow) (A). Spinal canal stenosis observed in lower cervical spine (B).
Fig. 4
Fig. 4. Postoperative lateral radiography after surgery. Oc-C3 fixation, C1 posterior arch resection, and C3-C7 laminoplasty was performed. Oc, occiput.
See this image and copyright information in PMC

References

    1. Kuntz D, Naveau B, Bardin T, Drueke T, Treves R, Dryll A. Destructive spondylarthropathy in hemodialyzed patients: a new syndrome. Arthritis Rheum. 1984;27:369–375. - PubMed
    1. Abumi K, Ito M, Kaneda K. Surgical treatment of cervical destructive spondyloarthropathy (DSA) Spine (Phila Pa 1976) 2000;25:2899–2905. - PubMed
    1. Han IH, Kim KS, Park HC, et al. Spinal surgery in patients with end-stage renal disease undergoing hemodialysis therapy. Spine (Phila Pa 1976) 2009;34:1990–1994. - PubMed
    1. Spinos P, Matzaroglou C, Partheni M, Deli A, Karanikolas M, Konstantinou D. Surgical management of cervical spondyloarthropathy in hemodialysis patients. Open Orthop J. 2010;4:39–43. - PMC - PubMed
    1. Sudo H, Ito M, Abumi K, et al. Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis. J Neurosurg Spine. 2006;5:313–319. - PubMed

LinkOut - more resources