Destructive spondyloarthropathy of the cervical spine in long-term hemodialyzed patients: a five-year clinical radiological prospective study.
OBJECTIVE
To describe the radiographic features and progression of cervical spine destructive spondyloarthropathy (DSA) in hemodialyzed patients, and to evaluate the relationship between this disease and patient characteristics, biochemical values, and hemodialysis duration.


METHODS
Standard radiographs, and lateral flexion and extension views of the cervical spine, were performed annually for 5 years in 31 hemodialyzed patients who were divided into three groups at the commencement of the study: those showing (I) DSA, (II) vertebral rim erosions (VRE) without DSA, and (III) absence of DSA and VRE. Magnetic resonance (MR) imaging and computed tomography (CT) were performed in seven and two patients respectively. The imaging features were evaluated for the presence and progression of spondyloarthropathy and correlated with clinical and biochemical variables. Statistical analysis was performed using one-way analysis of variance.


RESULTS
The duration of hemodialysis appeared to be the main predictive factor (P=0.0003) for DSA, which was found in six patients (19%). DSA was found to correlate with higher levels of beta2-microglobulin (P<0.00001), parathyroid hormone (P<0.05), and alkaline phosphatase (P<0.05). Clinical symptoms were minimal. In two patients, MR imaging revealed changes mimicking spondylodiscitis. In another patient, CT of the craniocervical junction showed bone resorption due to a pseudotumor, and basilar invagination.


CONCLUSIONS
DSA of the cervical spine is often clinically silent. Pathogenesis of DSA may be multifactorial but its progression is most influenced by the duration of hemodialysis. On MR imaging, DSA may mimic spondylodiscitis.
Leone
A
A
Department of Radiology, Università Cattolica, School of Medicine, Policlinico "Agostino Gemelli", Largo A. Gemelli, 8, 00168 Rome, Italy.
Sundaram
M
M
Cerase
A
A
Magnavita
N
N
Tazza
L
L
Marano
P
P
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D006435:Renal Dialysis / Q000009:adverse effects*; D013128:Spinal Osteophytosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology