Destructive spondyloarthropathy of the cervical spine in patients with chronic renal failure.
METHODS
Eleven patients with chronic renal failure and destructive spondyloarthropathy of the cervical spine were evaluated with plain radiographs, flexion-extension views, computed tomography myelogram, or magnetic resonance imaging to determine the results of surgical and nonsurgical treatment.


OBJECTIVE
To determine if cervical spine fusion is an effective method of treatment for patients with chronic renal failure and destructive spondyloarthropathy.


BACKGROUND
Several reports have described the pathogenesis and appearance of this condition, but little has been reported about the orthopedic management of destructive spondyloarthropathy of the cervical spine.


METHODS
Three patients had no spinal surgery, three patients had laminectomies alone, three patients had laminectomies with anterior fusions, and two patients had laminectomies with posterior fusions. Radiographs, computed tomography myelograms, and magnetic resonance images were evaluated to determine the results of treatment. Histologic examinations were performed in two patients.


RESULTS
Patients with laminectomy alone had no improvement in pain or neurologic function (one died in the immediate postoperative period), one of three patients with anterior fusions had some improvement (one died in the immediate postoperative period), and both of those patients with posterior fusions improved, although both died within a year of surgery from unrelated causes.


CONCLUSIONS
Even though the osteopenia present in patients with chronic renal failure tends to allow wire pull-out and makes internal fixation of the spine difficult, successful cervical spinal fusion can relieve pain and improve neurologic deficits in selected patients with chronic renal failure and destructive spondyloarthropathy, allowing them to remain more active for longer periods of time.
Kumar
A
A
Department of Orthopaedic Surgery, University of Tennessee Campbell Clinic, Memphis, USA.
Leventhal
M R
MR
Freedman
E L
EL
Coburn
J
J
Delamarter
R
R
D000368:Aged; D001851:Bone Diseases, Metabolic / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013122:Spinal Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy