RENAL OSTEODYSTROPHY OF THE CERVICAL-SPINE - NEUROSURGICAL IMPLICATIONS

RENAL OSTEODYSTROPHY DESCRIBES the changes in bone physiology seen in renal failure. Traditionally, these changes resulted in mild neurologi cal sequelae that were effectively managed medically. Despite the ofte n severe destruction seen on x-ray, surgical therapy has not been repo rted extensively. With increasing numbers of long-term hemodialysis su rvivors, however, a newly recognized erosive spondyloarthropathy with extensive bony destruction is seen more frequently. These changes can mimic the radiographic appearance of osteomyelitis, not an uncommon se quela of hemodialysis patients; therefore, this diagnosis must be cons idered. Although renal osteodystrophy can be seen throughout the spine , reports of significant cervical spine involvement are uncommon. We p resent our experience with six cases of renal osteodystrophy of the ce rvical spine requiring surgical intervention for instability or cord c ompression. Osteomyelitis was present in two of the patients. The path ophysiology and radiographic characteristics of renal osteodystrophy a nd the incidence of osteomyelitis are discussed. Fusion techniques, in cluding the use of anterior and posterior internal and external stabil ization, are presented. These patients represent a therapeutic challen ge for the neurosurgeon, given the underlying bone pathology.