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Surgical treatment of cervical destructive spondyloarthropathy (DSA)
1Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. abumi@med.hokudai.ac.jp
Study Design:
Sixteen patients with hemodialysis-associated cervical spine disorders underwent surgical treatment. After analysis of the surgical results, the optimum surgical procedures for these disorders were discussed.
Objective:
To evaluate the surgical results of cervical spine disorders associated with long-term hemodialysis and to propose the optimum surgical procedures for successful outcomes.
Summary Of Background Data:
There have been few reports regarding surgical results of hemodialysis-related cervical spine disorders. Surgical treatment for this disorder is still challenging.
Methods:
Sixteen patients with hemodialysis-associated cervical spine disorders were treated surgically. Duration of hemodialysis ranged from 8 to 27 years (average, 17 years). Before surgery, 14 patients showed severe cervical myelopathy, and the other 2 had radiculopathy in the upper extremities. Ten patients with marked destructive changes underwent circumferential reconstructive surgery involving pedicle screw fixation, anterior strut bone grafting, and posterior and/or anterior decompression. Two patients with cervical radiculopathy underwent posterior nerve root decompression by foraminotomy and fusion by pedicle screw fixation or spinous process wiring. The remaining four patients without spinal instability underwent posterior decompression by open-door laminoplasty.
Results:
Two patients died during follow-up. Follow-up periods in the surviving 14 patients ranged from 25 months to 92 months (average, 53 months). Marked neurologic recovery was obtained in all patients after surgery. Successful spinal fusion was obtained in all patients except one who underwent posterior fusion by spinous process wiring. Progressive destructive changes with significant instability at the adjacent mobile segments were observed in two patients who underwent circumferential fusion with a pedicle screw system more than 2 years after the initial surgery.
Conclusions:
The pedicle screw system achieved a high fusion rate in reconstructive surgery of cervical destructive spondyloarthropathy, even in the presence of severe bone fragility.