title: Surgical Outcome for Hemodialysis-Related Upper Cervical Lesions.
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To investigate the surgical outcome for hemodialysis-related upper cervical lesions.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Murata
authors.affiliation: Department of Orthopaedics, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Kato
keywords: Destructive spondyloarthropathy; Hemodialysis; Surgical outcome; Upper cervical spine