title: Challenges of cervical reconstruction for destructive spondyloarthropathy in renal osteodystrophy.
abstract: Patients with end stage renal disease on hemodialysis may present with destructive spondyloarthropathy of the spine, most commonly in the subaxial cervical and lumbar spine, often with severe stenosis and instability. However, surgical management of these patients is challenging due to a high pseudarthrosis rate, poor bone quality, and medical frailty. We present a 49-year-old man on hemodialysis who presented with C4-C5 vertebral body destruction and a focal kyphotic deformity with myelopathy. The patient underwent a 360 degree decompression and reconstructive procedure that resulted in posterior instrumentation failure. Several salvage techniques were used in order to adequately stabilize the spine while preserving the patient's remaining cervical motion.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA. Electronic address: belder4@jhmi.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
authors.forename: Rory J
authors.initials: RJ
authors.lastname: Petteys
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Room 6007, Baltimore, MD 21287, USA.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013123:Spinal Fusion / Q000379:methods; D025242:Spondylarthropathies / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Corpectomy; DSA; Destructive spondyloarthropathy; Myelopathy; Pseudarthrosis; Renal osteodystrophy