Clin Surg | Volume 1, Issue 1 | Research Article | Open Access

Surgical Treatment for Hemodialysis Associated Cervical Spondyloarthropathy

Kuroki H1*, Hamanaka H2, Inomata N2, Higa K2, Nagai T2 and Chosa E2

1Department of Orthopaedic Surgery, National Hospital Organization Miyazaki Higashi Hospital, Japan
2Department of Orthopaedic Surgery, University of Miyazaki, Japan

*Correspondance to: Hiroshi Kuroki 

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Abstract

Background: Hemodialysis associated cervical spondyloarthropathy (HA-CSA) is a serious pathology to affect not only quality of life but also life expectancy. The purpose of this study was to elucidate the long-term clinical results of surgical treatment for HA-CSA.Methods: Ten of the 15 patients (9 male and 1 female, mean age of 61 years) of HA-CSA who were surgically treated and underwent periodic follow-up review for more than 5 years after surgery were enrolled in this study. We retrospectively investigated preoperative complications, surgical procedures, treatment outcomes, and perioperative complications.Results: Various preoperative complications were observed in all cases except 1. Posterior decompression and fusion was performed in 4 cases, posterior fusion in 1, and laminoplasty in 5. Japanese Orthopaedic Association (JOA) score excluding bladder function (on a 14-point scale) improved 4.6 points postoperatively (mean recovery rate: 46.9%). Perioperative complications occurred in 5 cases. In 8 cases, a lumbar destructive lesion with spinal canal stenosis was developed and 3 of them were subsequently performed lumbar decompressive surgery.Conclusion: Pathological conditions of HA-CSA are divided into proliferation of the soft tissue and destruction of the bony tissue. Even in hemodialysis patients, decompressive procedure must warrant long-term acceptable clinical results if the basal cause of symptom is spinal canal stenosis due to proliferation of the soft tissue. When selecting fusion surgery for the patient with the destructive change, shorter posterior fusion should be adopted to reduce invasiveness of surgery. Although the risk of surgery must be extremely high in the patient on hemodialysis due to problems of general conditions, favorable clinical results are anticipated if no perioperative complications have been encountered. However, progression of lumbar lesion deteriorated the physical function again even though improvement of symptoms by cervical lesion relatively maintained for a long time after surgery.

Keywords:

Cervical spine; Destructive spondyloarthropathy; Hemodialysis; Surgical treatment and β2-microgloblin

Citation:

Kuroki H, Hamanaka H, Inomata N, Higa K, Nagai T, Chosa E. Surgical Treatment for Hemodialysis Associated Cervical Spondyloarthropathy. Clin Surg. 2016; 1: 1102.

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