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Kitanaka S, Takatori R, Tonomura H, Shimizu Y, Nagae M, Makinodan A, Takahashi K. Clinical Outcomes of Lateral Lumbar Interbody Fusion with Percutaneous Pedicle Screw for Dialysis-Related Spondyloarthropathy. J Clin Med 2024; 13:1089. [PMID: 38398402 PMCID: PMC10889300 DOI: 10.3390/jcm13041089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/04/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The usefulness and problems with lateral lumbar interbody fusion (LLIF) with a percutaneous pedicle screw (PPS) for dialysis-related spondyloarthropathy are not clear. Therefore, we investigated the usefulness and problems with LLIF with PPS in dialysis-related spondyloarthropathy. Methods: In total, 77 patients who underwent LLIF with PPS were divided into two groups: the dialysis-related spondyloarthropathy group ("Group D") consisted of 15 patients (10 males and 5 females) with a mean age of 70.4 years and a mean duration of hemodialysis of 10.8 years; and the lumbar degenerative disease group ("Group L") included 62 patients (31 males and 31 females) with a mean age of 71.0 years. The mean follow-up period was 4 years in Group D and 3 years 9 months in Group L. We compared surgical invasiveness (operative time, blood loss), perioperative complications, clinical outcomes (Improvement ratio of the JOA score), bone fusion rate, reoperation, sagittal alignment, and coronal imbalance between the two groups. Results: There were no significant differences in operative time, blood loss, or the improvement ratio of the JOA score, but dialysis-related spondyloarthropathy was observed in one patient with superficial infection, three patients with endplate failure, and one patient with restenosis due to cage subsidence. Conclusions: We consider LLIF with PPS for dialysis-related spondyloarthropathy to be an effective treatment option because its surgical invasiveness and clinical outcomes were comparable to those for cases of lumbar degenerative disease. However, as endplate failure due to bone fragility and a reduced bone fusion rate were observed in dialysis spondylolisthesis cases, we advise a careful selection of indications for indirect decompression as well as the application of suitable pre- and postoperative adjuvant therapies.
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Affiliation(s)
- Shigeyuki Kitanaka
- Department of Orthopedic Surgery, Nishijin Hospital, Kyoto 602-8319, Japan;
| | - Ryota Takatori
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Hitoshi Tonomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Yuichi Shimizu
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Masateru Nagae
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
| | - Atsushi Makinodan
- Department of Orthopedic Surgery, Nishijin Hospital, Kyoto 602-8319, Japan;
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (R.T.); (H.T.); (Y.S.); (M.N.); (K.T.)
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Yasukawa T, Ohya J, Kawamura N, Yoshida Y, Onishi Y, Kohata K, Kakuta Y, Nagatani S, Kudo Y, Shirahata T, Kunogi J. Dynamization-Posterior Lumbar Interbody Fusion for Hemodialysis-Related Spondyloarthropathy: Evaluation of the Radiographic Outcomes and Reoperation Rate within 2 Years Postoperatively. Asian Spine J 2022; 16:684-691. [PMID: 35255544 DOI: 10.31616/asj.2021.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Clinical case series. Purpose This study aimed to report dynamization-posterior lumbar interbody fusion (PLIF), our surgical treatment for hemodialysisrelated spondyloarthropathy (HSA), and investigate patients' postoperative course within 2 years. Overview of Literature HSA often requires lumbar fusion surgery. Conventional PLIF for HSA may cause progressive destructive changes in the vertebral endplate, leading to progressive cage subsidence, pedicle screw loosening, and pseudoarthrosis. A dynamic stabilization system might be effective in patients with a poor bone quality. Thus, we performed "dynamization-PLIF" in hemodialysis patients with destructive vertebral endplate changes. Methods We retrospectively examined patients with HSA who underwent dynamization-PLIF at our hospital between April 2010 and March 2018. The radiographic measurements included lumbar lordosis and local lordosis in the fused segment. The evaluation points were before surgery, immediately after surgery, 1 year after surgery, and 2 years after surgery. The preoperative and postoperative radiographic findings were compared using a paired t-test. A p-value of less than 0.05 was considered significant. Results We included 50 patients (28 males, 22 females). Lumbar lordosis and local lordosis were significantly improved through dynamization- PLIF (lumbar lordosis, 28.4°-35.5°; local lordosis, 2.7°-12.8°; p<0.01). The mean local lordosis was maintained throughout the postoperative course at 1- and 2-year follow-up (12.9°-12.8°, p=0.89 and 12.9°-11.8°, p=0.07, respectively). Solid fusion was achieved in 59 (89%) of 66 fused segments. Solid fusion of all fixed segments was achieved in 42 cases (84%). Within 2 years postoperatively, only six cases (12%) were reoperated (two, surgical debridement for surgical site infection; two, reoperation for pedicle screw loosening; one, laminectomy for epidural hematoma; one, additional fusion for adjacent segment disease). Conclusions Dynamization-PLIF showed local lordosis improvement, a high solid fusion rate, and a low reoperation rate within 2 years of follow-up.
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Affiliation(s)
- Taiki Yasukawa
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.,Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Ohya
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuichi Yoshida
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuki Onishi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazuhiro Kohata
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yohei Kakuta
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Satoshi Nagatani
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yoshifumi Kudo
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Toshiyuki Shirahata
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Junichi Kunogi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Tagami A, Tomita M, Adachi S, Tsuda K, Yamada S, Chiba K, Okazaki N, Yonekura A, Tsujimoto R, Kajiyama S, Matsubayashi S, Miyamoto T, Mochizuki Y, Ohba K, Osaki M. Epidemiological survey and risk factor analysis of dialysis-related amyloidosis including destructive spondyloarthropathy, dialysis amyloid arthropathy, and carpal tunnel syndrome. J Bone Miner Metab 2020; 38:78-85. [PMID: 31414282 DOI: 10.1007/s00774-019-01028-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022]
Abstract
The RDT population, initially at 215 patients, exceeded 300,000 in 2011, with a total of 329,609 patients at the end of December 2016. In our Institute, the number of patients with destructive spondylosis is increasing with the increase in the number of dialysis patients in Japan. We had 14 Cases in the 1990s, and then 82 cases in the 2000s and have already had 131 cases in the 2010s. The purpose of this study was to investigate the incidence of dialysis-related amyloidosis (DRA) such as destructive spondyloarthropathy (DSA), dialysis amyloid arthropathy (DAA), and carpal tunnel syndrome (CTS). In addition, another purpose was to examine the risk factors of the DRA. DAA made its own assessment on radiographs based on stage. Survey items were patient's basic data, laboratory data and X-ray view. Patient's basic data included such as sex, age, height, and weight and RDT-related factors such as kidney disease that led to RDT, age at start of RDT, RDT history, medical history (past and present), and history of surgery. The frequency of DRA was examined by medical history and radiological examination in 199 dialysis patients who obtained informed consent. The patients were divided into two groups according to the presence or absence of DRA, and risk factors of DRA were investigated from the medical history, basic data of patients, and blood tests. Of the 199 patients on regular dialysis therapy, 41 (20.6%) showed DRA. Based on the X-ray images, 21 patients (10.6%) showed DSA, while 22 patients (11.1%) showed DAA. Sixteen patients (8.0%) had CTS, determined through a history of surgery. Regarding overlap of conditions, 14 had both DSA and DAA, 3 had both DSA and CTS, and 2 had both DAA and CTS. There were statistically significant differences between the two groups in the cause of disease in Chronic glomerulonephritis and Diabetic Nephropathy, age at the start of RDT, period of RDT, body weight, blood platelet count, and blood Ca level. When multivariate analysis was performed on these items, statistical differences were recognized only during the dialysis period. In conclusion, long dialysis period was a risk factor for DRA.
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Affiliation(s)
- Atsushi Tagami
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Masato Tomita
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Shinji Adachi
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keiichi Tsuda
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shuta Yamada
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Koh Chiba
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Narihiro Okazaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Ritsu Tsujimoto
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shiro Kajiyama
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shohei Matsubayashi
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takashi Miyamoto
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yasushi Mochizuki
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Nishi S, Yamamoto S, Hoshino J, Takaichi K, Naiki H. The features of bone articular lesions in dialysis-related amyloidosis (DRA) and criteria for the clinical diagnosis of DRA. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0205-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bedani P, Orzincolo C, Storari A, Perini L, Soffritti S, Gilli P. Clinical and Radiological Features of Bone Disease in Long-Term (15 or more years) Hemodialysis Patients. Int J Artif Organs 2018. [DOI: 10.1177/039139889301601005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fifteen patients on regular dialytic treatment for more than 15 years were given X-rays of the skull, spine, shoulders, wrists, pelvis and knees with the purpose of studying the principal skeletal and articular alterations due or not due to the uraemic status. Serum calcium, phosphorus, parathyroid hormone, alkaline phosphatase and basal aluminium were recorded. Osteopenia was evident in all the patients. Ten of whom (67%) showed alterations due to hyperparathyroidism. Nine patients presented the marks of dialysis spondyloarthropathy; in 14/15 cases geodes were present in the wrists, humeral heads or hip-joints; in ten patients there were multiple amyloid lesions. Two patients with serum basal aluminum above 100 μg/L showed the typical radiographic marks of osteomalacia. The majority of the long-term survivors showed multifactorial osteo-articular alterations resulting mainly from the combination of hyperparathyroidism and dialysis-related amyloidosis. The less frequent joint alterations were represented by arthrosis, enthesopathy and Chondrocalcinosis. Disability and decreased articular mobility resulted in being mainly due to amyloid osteo-arthropathy.
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Affiliation(s)
| | - C. Orzincolo
- Division of Service of Radiology, S. Anna Hospital, Ferrara - Italy
| | | | - L. Perini
- Division of Nephrology Ferrara - Italy
| | | | - P. Gilli
- Division of Nephrology Ferrara - Italy
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Abstract
The bone marrow basically consists of red blood-forming bone marrow and yellow fat. In the skeleton, there is an age-dependent distribution of these two parts. In the context of medical interventions or therapies, bone marrow changes can occur, whereby the normal bone marrow can basically be replaced by fat, edema, or fibrosis/sclerosis. Here, specific signal intensities and patterns are shown in imaging. After irradiation therapies, edematous changes, hemorrhages, and osteoradionecroses are observed. Likewise, insufficiency fractures, impairment of the growth gaps, or the development of tumors is possible. In patients on dialysis, deposit of protein in the bone marrow is possible in the case of the so-called amyloidosis osteoarthropathy. Postoperative bone marrow edema, insufficiency fractures, or osteonecrosis can be observed after arthroscopy. Changes in the distribution of fat markers and blood-forming bone marrow can be observed after stem cell transplants. In the therapy with cortisone, insufficiency fractures and osteonecroses are possible. Depending on their effect on the hematopoietic system, chemotherapyies can first lead to edematous changes and then to fatty bone marrow, which is reversible after therapy. Angiogenesis inhibitors in combination with other chemotherapeutic agents often lead to mixed images of stimulated and fatty bone marrow.
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Affiliation(s)
- T Geith
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland.
| | - A-C Stellwag
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
| | - A Baur-Melnyk
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Marchioninistraße 15, 81375, München, Deutschland
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Maruo K, Moriyama T, Tachibana T, Inoue S, Arizumi F, Kusuyama K, Yoshiya S. Prognosis and adjacent segment disease after lumbar spinal fusion surgery for destructive spondyloarthropathy in long-term hemodialysis patients. J Orthop Sci 2017; 22:248-253. [PMID: 28027828 DOI: 10.1016/j.jos.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/31/2016] [Accepted: 12/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lumbar destructive spondyloarthropathy (DSA) is a serious complication in long-term hemodialysis patients. There have not been many reports regarding the surgical management for lumbar DSA. In addition, the adjacent segment pathology after lumbar fusion surgery for DSA is unclear. The objective of this study was to assess the clinical outcome and occurrence of adjacent segmental disease (ASD) after lumbar instrumented fusion surgery for DSA in long-term hemodialysis patients. MATERIALS AND METHODS A consecutive series of 36 long-term hemodialysis patients who underwent lumbar instrumented fusion surgery for DSA were included in this study. The mean age at surgery was 65 years. The mean follow-up period was 4 years. Symptomatic ASD was defined as symptomatic spinal stenosis or back pain with radiographic ASD. The Japanese Orthopedic Association score (JOA score), recovery rate (Hirabayashi method), complications, and reoperation were reviewed. RESULTS The mean JOA score significantly increased from 13.5 before surgery to 21.3 at the final follow-up. The mean recovery rate was 51.4%. Six of the 36 patients died within 1 year after index surgery. One patient died due to perioperative complication. Symptomatic ASD occurred in 43% (13 of 30) of the cases. Of these 13 cases, 5 had adjacent segment disc degeneration and 8 had adjacent segment spinal stenosis. Three cases (10%) required reoperation due to proximal ASD. Multi-level fusion surgery increased the risk of ASD compared with single-level fusion surgery (59% vs. 23%). The recovery rate was significantly lower in the ASD group than the non-ASD group (38% vs. 61%). DISCUSSION This study demonstrated that symptomatic ASD occurred in 43% of patients after surgery for lumbar DSA. A high mortality rate and complication rate were observed in long-term hemodialysis patients. Therefore, care should be taken for preoperative planning for surgical management of DSA.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
| | | | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Inoue
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Jeong JH, Kim HK, Im SB. Surgical Management for Destructive Atlantoaxial Spondyloarthropathy in Long-Term Hemodialysis Patients. World Neurosurg 2016; 97:753.e7-753.e16. [PMID: 27771479 DOI: 10.1016/j.wneu.2016.10.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atlantoaxial spondyloarthropathy most often results from rheumatoid arthritis, cancer metastasis, or basilar invagination. Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy at the atlantoaxial joint. We report 2 patients on long-term hemodialysis who presented with atlantoaxial spondyloarthropathy. CASE DESCRIPTION Two patients with end-stage renal failure presented with a history of progressively worsening neck pain, motion limitation, and gait disturbance. In both patients, radiologic findings showed a bone-destroying soft tissue mass lateral to C1 and C2, compressing the spinal cord and causing atlantoaxial instability. We performed a C1 laminectomy and C12 transarticular screw fixation and biopsied the osteolytic mass. The neck pain, hand numbness, and gait disturbance improved. CONCLUSIONS Although the surgical management of these patients involves many challenges, appropriate decompression and fusion surgery is an effective treatment option.
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Affiliation(s)
- Je Hoon Jeong
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea
| | - Hee Kyung Kim
- Department of Pathology, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea
| | - Soo Bin Im
- Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, Republic of Korea.
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The relationship between the type of destructive spondyloarthropathy and its 10 years ago cervical spine alignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:900-4. [PMID: 19350288 DOI: 10.1007/s00586-009-0957-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 02/22/2009] [Accepted: 03/21/2009] [Indexed: 10/20/2022]
Abstract
The objective of this retrospective study was to analyze the relationship between the type of destructive spondyloarthropathy (DSA) and its 10 years ago cervical spine alignment. DSA was reported as a serious complication of long-term hemodialysis. Although previous reports in regard to risk factor of DSA dealt with the period of hemodialysis and the patient's age upon commencement of hemodialysis, we could not find any reports of the relationship between the type of DSA and its 10 years ago cervical spine alignment. In 96 DSA patients who were the subjects of our study, 8 patients were defined as stage 1, 39 patients as stage 2, 5 patients as stage 3 type A, 11 patients as stage 3 type B, and 33 patients as stage 3 type D. The C2/C7 angle of stage 3 type B was statistically low. The number of the abnormal local cervical alignment was larger in stage 3 types A and B. Multivariate analysis revealed that the risk factors of stage 3 types A and B were the C2/C7 angle and the existence of local abnormal alignment. Fifty-four patients were symptomatic due to DSA and treated at our hospital. Forty-four patients were treated conservatively with medications, physiotherapy, or wearing cervical brace. Ten patients underwent surgical treatment. The loss of physiological lordosis of cervical spine promoted the progression of DSA. Furthermore, the number of the abnormalities of local cervical alignment was statistically larger in stage 3 types A and B; they were the crucial factor promoting the progression of DSA stage 3 types A and B.
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Kay J. Shoulder Pain in the Dialysis Patient. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1995.tb00353.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yuzawa Y, Kamimura M, Nakagawa H, Kinoshita T, Itoh H, Takahashi J, Ebara S. Surgical Treatment with Instrumentation for Severely Destructive Spondyloarthropathy of Cervical Spine. ACTA ACUST UNITED AC 2005; 18:23-8. [PMID: 15687848 DOI: 10.1097/01.bsd.0000133494.70621.2e] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nine patients with severely destructive spondyloarthropathy and marked neurologic deficits associated with dialysis-related amyloidosis underwent posterior decompression and fusion by means of instrumentation at our institute. All patients showed segmental kyphosis, six patients vertebral ankylosis, and eight patients spondylolisthesis. Spondylolisthesis at two levels was noted in three patients. Of the 11 levels of spondylolisthesis in all, 9 were proximally adjacent and 2 were distally adjacent to vertebral ankylosis. All patients underwent posterior decompression and multisegment fusion with autogenous iliac bone. From three to five spinal segments were fixed. Seven patients underwent posterior fusion by means of a pedicle or lateral mass screw between levels C3 and C7, one patient between C3 and C6, and one between C3 and T1. The clinical rate of improvement at the final follow-up was 74.3%. Though complete stability could not be achieved in three patients, the results were rated as good. No postoperative neurologic deterioration has been observed in this series, nor did any patients die immediately after surgery or during the postoperative follow-up period. As anterior long-span surgery might be too invasive for hemodialysis patients, we think that posterior decompression and fusion may well be a reasonable and effective strategy for severe hemodialysis-associated cervical spondyloarthropathy with neurologic deficits. To achieve complete stability, 360 degrees fusion with both anterior and posterior fixation with instrumentation may be required for these patients.
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Affiliation(s)
- Yohei Yuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Aizawa Hospital, 2-5-1 Honjo, Matsumoto City, Nagano 390-8510, Japan.
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Inatomi K, Matsumoto T, Tomonaga T, Eto M, Shindo H, Hayashi T, Konishi H. Histological analysis of the ligamentum flavum of patients with dialysis-related spondyloarthropathy. J Orthop Sci 2004; 9:285-90. [PMID: 15168185 DOI: 10.1007/s00776-004-0767-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2003] [Accepted: 01/14/2004] [Indexed: 10/26/2022]
Abstract
Dialysis-related spondyloarthropathy (DRS) is a severe complication of long-term hemodialysis that ultimately leads to functional disability of the upper and lower extremities. Although the cause of this disease is still unknown, it is thought that amyloid deposits are involved. beta2-Microglobulin (beta2M) is a major component of amyloid fibrils, some of which are modified with the advanced glycation end-product (AGE). To clarify the pathophysiology of DRS we histologically examined the ligamentum flavum of the cervical spine in 15 patients with DRS. The mean duration of hemodialysis was 20 years (12-27 years). In addition to the congo red stain for amyloid, beta2M and AGE were detected by immunohistochemical methods. Macrophages were stained with CD68 antibody. Amyloid deposits were found in tissues, although the extent of the stained area differed among the patients. Part of the amyloid deposit area was positively immunostained for beta2M and AGE. In 10 cases macrophages positive for CD68 infiltrated around the amyloid deposits. Comparing these histological findings with the dialysis duration, more positive staining areas for beta2M and AGE were found in the tissue from patients with long-term dialysis. These findings suggest that both beta2M and AGE play roles in the pathogenesis of DRS.
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Affiliation(s)
- Kenshiro Inatomi
- Department of Orthopedic Surgery, School of Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Kamimura M, Nakagawa H, Uchiyama S, Takahara K, Itsubo T, Miyasaka TA. Progressive symptomatic kyphotic deformity after decompressive surgery for lumbar destructive spondyloarthropathy. J Clin Neurosci 2004; 11:415-8. [PMID: 15080960 DOI: 10.1016/j.jocn.2003.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2002] [Accepted: 04/07/2003] [Indexed: 10/26/2022]
Abstract
Destructive spondyloarthropathy (DSA) is a serious complication of haemodialysis for end stage renal failure. We present a case of a patient who complained of back pain and cruralgia due to L2-3 disc degeneration with instability, and was treated with posterior decompression and bone grafting. Soon after surgery, the kyphotic deformity progressed and the symptoms deteriorated. A correction of the deformity and posterior fusion was required six years after initial surgery. Pathological findings showed characteristic findings of DSA. Our findings indicate that in some cases with unstable DSA, spinal decompression as well as spinal fixation may be necessary.
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Affiliation(s)
- Mikio Kamimura
- Suwa Red Cross Hospital, Department of Orthopaedic Surgery, Nagano 392-8510, Japan.
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Abstract
Destructive spondyloarthropathy has recently been described in patients who undergo maintenance hemodialysis for chronic renal disease. The condition most frequently involves the lower segment of the cervical spine, although the craniocervical junction also may be affected. Although the pathogenesis of destructive spondyloarthropathy remains unclear, the disorder is thought to relate to a hemodialysis-associated amyloidosis. It appears that the disease correlates with the duration of hemodialysis, although it has been reported in patients with chronic renal insufficiency not associated with hemodialysis. Radiographic features simulate those of an infectious process, encompassing a range of abnormalities from superficial erosions to large bony defects. Computed tomography (CT) images reveal osteolytic areas, with bone sclerosis of adjacent vertebral endplates, and minimal osteophytosis. The intervertebral spaces appear narrow or obliterated. On magnetic resonance imaging (MRI), the disorder may show the imaging characteristics of spondylodiskitis. The absence of high signal intensity on T2-weighted images generally helps to eliminate the diagnosis of an infection. With progression of the disease, collapse of a vertebral body and spinal instability may occur. Severe complications of destructive spondyloarthropathy in long-term dialysis patients may include spinal cord compromise, necessitating surgical decompression, with or without spinal stabilization.
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Affiliation(s)
- Daphne J Theodorou
- Department of Radiology, School of Medicine, University of California, San Diego Medical Center, USA.
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16
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Kay J, Bardin T. Osteoarticular disorders of renal origin: disease-related and iatrogenic. Best Pract Res Clin Rheumatol 2000; 14:285-305. [PMID: 10925746 DOI: 10.1053/berh.2000.0066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteoarticular disorders significantly limit the quality of long-term survival with chronic renal failure. beta 2M amyloidosis is a complication of chronic renal failure that has been recognized mostly in patients receiving long-term haemodialysis. Patients with beta 2M amyloidosis typically present with the triad of shoulder periarthritis, carpal tunnel syndrome, and flexor tenosynovitis of the hands. Other musculoskeletal manifestations of beta 2M amyloidosis include destructive spondyloarthropathy, cervico-occipital pseudotumours, bone cysts, and pathological fractures. At present, only renal transplantation may slow or halt the progession of beta 2M amyloidosis. Crystal-induced arthropathy, most commonly caused by basic calcium phosphate crystals, is an important cause of acute joint inflammation in the patient with renal failure. The incidence of bone and joint infection is increased in patients undergoing dialysis. Haemodialysis and peritoneal dialysis are also associated with an erosive or destructive arthropathy of finger joints, which is not explained by local amyloid deposition.
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Affiliation(s)
- J Kay
- Department of Internal Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, USA
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17
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Pak F, Lash J. Destructive Spondyloarthropathy: An Overview. Int J Artif Organs 1999. [DOI: 10.1177/039139889902200802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F. Pak
- Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, IL - USA
| | - J. Lash
- Department of Medicine, Section of Nephrology, University of Illinois at Chicago, Chicago, IL - USA
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Ito M, Abumi K, Takeda N, Satoh S, Hasegawa K, Kaneda K. Pathologic features of spinal disorders in patients treated with long-term hemodialysis. Spine (Phila Pa 1976) 1998; 23:2127-33. [PMID: 9794059 DOI: 10.1097/00007632-199810010-00018] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Pathologic features of hemodialysis-associated spinal disorders were evaluated using preoperative radiographic images and histologic findings of the spinal lesions resected during surgery. OBJECTIVES To investigate the pathology of hemodialysis-related spinal disorders and to determine the role of amyloidosis in the establishment of severe destruction of the spine. SUMMARY OF BACKGROUND DATA The pathologic events leading to hemodialysis-associated spinal disorders are poorly understood. The distribution of amyloid deposits in the spine also has not been clarified. METHODS Twenty patients with hemodialysis-associated spinal disorders were investigated regarding pathologic features of neural compression and spinal destruction. Preoperative radiographic images such as plain radiography, tomography, computed tomography, magnetic resonance imaging, and scintigraphy were assessed for the existence of an intracanal mass, hypertrophy of the ligamentum flavum, and destructive changes of the spinal components. Histologic examination also was conducted by light microscopy and scanning electron microscopy to determine the distribution pattern of amyloid deposits in the spinal components. RESULTS Six patients with no destructive changes in the spine showed spinal canal stenosis. In the cervical spine, a main factor associated with spinal canal stenosis was the presence of intracanal amyloid deposits in three patients. In the lumbar spine, a main factor associated with spinal canal stenosis was hypertrophied ligamentum flavum in three patients. Destructive changes of the facet joints, intervertebral disc, and vertebral body were seen in the other 14 patients. Amyloid deposits were densely distributed at the enthesis of capsular fibers to the bone and in anular tears in the intervertebral discs. Vertebral end plates were destroyed by penetration of amyloid granulation into the vertebral body. Osteoclast activity in the destroyed vertebral bodies was enhanced, with no evidence of new bone formation. CONCLUSIONS Amyloid deposits played an important role in the progression of spinal destruction and severe instability.
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Affiliation(s)
- M Ito
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
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Kumar A, Leventhal MR, Freedman EL, Coburn J, Delamarter R. Destructive spondyloarthropathy of the cervical spine in patients with chronic renal failure. Spine (Phila Pa 1976) 1997; 22:573-7; discussion 578. [PMID: 9076892 DOI: 10.1097/00007632-199703010-00024] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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.
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Affiliation(s)
- A Kumar
- Department of Orthopaedic Surgery, University of Tennessee Campbell Clinic, Memphis, USA
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Cuffe MJ, Hadley MN, Herrera GA, Morawetz RB. Dialysis-associated spondylarthropathy. Report of 10 cases. J Neurosurg 1994; 80:694-700. [PMID: 8151349 DOI: 10.3171/jns.1994.80.4.0694] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Ten patients undergoing long-term renal dialysis for end-stage renal failure developed a destructive, non-infectious spondylarthropathy. All 10 patients had biopsy-proven dialysis-associated spondylarthropathy and subsequent spinal instability secondary to beta 2-microglobulin deposition in the vertebrae, intervertebral disc spaces, and support structures of the spine. Nine patients had cervical spinal instability and one had thoracolumbar spinal instability, with resultant neural compression. In at least one patient, the spinal instability was rapidly progressive. All had received renal dialysis for 34 months or longer (mean 109 months, range 34 to 154 months). Each patient required spinal stabilization (external in seven patients, internal in three). Nine of the 10 patients underwent neural decompression and spinal stabilization and fusion procedures. One patient's neurological condition was worse following surgery due to a postoperative cervical epidural hematoma; in the other nine patients, the presenting symptoms and signs improved. Three of these chronically ill patients did not survive their hospitalization, for a perioperative mortality rate of 30%. Death was due to cardiopulmonary arrest in two patients on Day 5 and 9 postoperatively and to sepsis in the third on Day 14. Of the seven early survivors, two additional patients died: one on Day 59 due to congestive heart failure and the other on Day 273 due to a cerebrovascular accident. Four of five patients who were followed for 8 months or longer (mean 14 months, range 8 to 20 months) had successful neural decompression and spinal stabilization procedures with evidence of stable bone fusion, indicating that these chronically ill, difficult-to-manage patients can be successfully treated. Clinicians who treat patients with renal disease and neurosurgeons who treat spinal disorders should be aware of dialysis-associated spondylarthropathy as a potential cause of degenerative vertebral column instability.
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Affiliation(s)
- M J Cuffe
- Department of Surgery, University of Alabama, Birmingham
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Gravallese EM, Baker N, Lester S, Kay J, Owen WF. Musculoskeletal manifestations in beta 2-microglobulin amyloidosis. Case discussion. ARTHRITIS AND RHEUMATISM 1992; 35:592-602. [PMID: 1575795 DOI: 10.1002/art.1780350518] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The cases presented illustrate some of the typical (case 1) and less common (case 2) clinical features of beta 2m amyloidosis. The accumulation of beta 2m amyloid in tissues is a potentially severe complication of dialysis-treated chronic renal failure. Beta 2m amyloidosis has been shown to have distinct clinical, radiologic, and pathologic features. The pathogenesis of this condition is not yet clearly understood, and recommendations for the clinical management of these patients at present are limited to recognition of the disease and symptomatic treatment. Further insights into the biology of this disease should lead to new strategies for prevention and treatment.
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Affiliation(s)
- E M Gravallese
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Westmark KD, Weissman BN. Radiologic vignette. Amyloid arthropathy accompanying hemodialysis. ARTHRITIS AND RHEUMATISM 1991; 34:1061-4. [PMID: 1859482 DOI: 10.1002/art.1780340818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K D Westmark
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115
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Rousselin B, Helenon O, Zingraff J, Delons S, Drueke T, Bardin T, Moreau JF. Pseudotumor of the craniocervical junction during long-term hemodialysis. ARTHRITIS AND RHEUMATISM 1990; 33:1567-73. [PMID: 2222537 DOI: 10.1002/art.1780331015] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A systematic study of the upper cervical spine was performed using magnetic resonance imaging in 25 patients (15 men and 10 women) who had been undergoing hemodialysis for more than 10 years. Seven pseudotumors of the periodontoid soft tissue were disclosed, which were similar to the pannus recently described in rheumatoid arthritis. Bone cystic radiolucencies were observed in association with these pseudotumors in 5 patients. The radiolucencies were located in the atlas (1 in the lateral mass and 1 in the anterior branch) and in the axis (3 in the odontoid process and 1 in the vertebral body). No horizontal or vertical atlantoaxial subluxation was demonstrated. These features were observed only in patients who had amyloid arthropathy. They could be a frequent, yet thus far little-recognized, feature of beta 2-microglobulin amyloidosis.
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Affiliation(s)
- B Rousselin
- Service de Radiologie, INSERM, Hôpital Necker, Paris, France
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