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Destructive Spondyloarthropathy of the Cervical Spine in Patients With Chronic Renal Failure

Kumar, Anant, MD*; Leventhal, Marvin R., MD*; Freedman, Eric L., MD; Coburn, Jack, MD; Delamarter, Rick, MD

Case Reports

Study design. 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.

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

Summary of background data. 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.

From the *Department of Orthopaedic Surgery, University of Tennessee Campbell Clinic, Memphis, Tennessee, and the Departments of Orthopaedic Surgery and ‡Nephrology, University of California at Los Angeles, Los Angeles, California.

Acknowledgment date: February 24, 1994.

First revision date: August 16, 1995.

Second revision date: January 30, 1996.

Acceptance date: May 7, 1996.

Device status category: 1.

Address requests for reprints to: Anant Kumar, MD; 869 Madison Avenue; Memphis, TN 38103.

© Lippincott-Raven Publishers.