| ABSTRACT: |
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. |