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Destructive spondyloarthropathy of the lumbar spine in patients on long-term haemodialysis: a computed
Yutaka Yabe1,2, Keisuke Ishikawa3, Daisuke Kurosawa4
1Department of Orthopaedic Surgery, National Hospital Organization Sendai Nishitaga Hospital, Sendai, Japan. yabe@med.tohoku.ac.jp.
Insights
Destructive spondyloarthropathy (DSA) affects 31.3% of haemodialysis patients undergoing lumbar surgery. Longer dialysis duration may be linked to lumbar DSA development.
Area of Science:
- Nephrology
- Orthopedic Surgery
- Radiology
Background:
- Destructive spondyloarthropathy (DSA) is a severe complication associated with long-term haemodialysis, frequently affecting the cervical spine.
- While lumbar spine DSA is documented, research on its prevalence and patient characteristics remains limited.
Purpose of the Study:
- To determine the prevalence of lumbar destructive spondyloarthropathy (DSA) in patients undergoing lumbar spine surgery.
- To identify the clinical characteristics associated with lumbar DSA in this patient cohort.
- To evaluate the reliability of computed tomography (CT) in classifying lumbar DSA.
Main Methods:
- A cohort of 67 patients undergoing haemodialysis and lumbar spine surgery were analyzed.
- Patients were categorized into non-DSA and DSA groups based on CT imaging.
- Clinical characteristics were compared between the two groups to identify significant differences.
Main Results:
- The prevalence of lumbar DSA was found to be 31.3% among the studied patients.
- CT-based classification of DSA demonstrated moderate-to-substantial inter-observer agreement (kappa values 0.68 and 0.53).
- No significant differences were observed in age, sex, BMI, surgical indication, or dialysis-related factors, except for a trend towards longer haemodialysis duration in the DSA group.
Conclusions:
- Lumbar destructive spondyloarthropathy (DSA) is prevalent in 31.3% of haemodialysis patients who undergo lumbar spine surgery.
- CT imaging provides a reliable method for classifying lumbar DSA.
- A longer duration of haemodialysis may be a contributing factor to the development of lumbar DSA.
Purpose:
Destructive spondyloarthropathy (DSA) is a serious complication of long-term haemodialysis; it commonly occurs in the cervical spine and has been investigated in cervical lesions. Although DSA of the lumbar spine has been reported, only few studies have investigated this, and the characteristics of patients with lumbar DSA are unclear. The present study aimed to elucidate the prevalence of DSA and its clinical characteristics in patients with DSA in the lumbar spine using computed tomography (CT) images of the patients who underwent lumbar spine surgery.
Methods:
Consecutive patients undergoing haemodialysis who underwent lumbar spine surgery (n = 67) were assessed. DSA was diagnosed using CT images, and the patients were divided into non-DSA and DSA groups. The differences in the clinical characteristics of the patients in the two groups were analysed.
Results:
The prevalence of patients diagnosed with DSA was 31.3%. The mean intra- and inter-observer kappa values of DSA classification using CT images were 0.68 and 0.53, respectively. Although there were no significant differences in the age, sex, body mass index, reason for lumbar surgery, disease causing haemodialysis, age at the start of haemodialysis, or duration of haemodialysis between the non-DSA and DSA groups, the duration of haemodialysis tended to be longer in the DSA group.
Conclusion:
Among patients on haemodialysis who underwent lumbar spine surgery, the prevalence of patients with DSA was 31.3%. Classification of DSA using CT showed moderate-to-substantial agreement. Patients with DSA tended to have a longer haemodialysis duration.
