Destructive spondyloarthropathies associated with chronic hemodialysis. Two cases involving the cervical spine.

Destructive spondyloarthropathies (DSAs) associated with chronic hemodialys is are characterized by loss of disk height with endplate erosions and cyst s but no significant osteophytosis. The main differential diagnoses are ost eoarthritis in early forms and infectious discitis in severe forms. Patient s and methods: plain radiographs of the cervical spine were obtained routin ely in 69 hemodialysis patients, Results. two cases of cervical DSA were id entified in patients with no other detectable causes of cervical spine dise ase. Case 1. this 60-year-old woman on hemodialysis since 1980 reported a t wo-year history of neck pain and was found to have narrowing of the disk sp aces from C3 to C7 with endplate erosions at C3-C4 and C6-C7 but no osteoph ytosis, Case 2. in this 54-year-old woman with an eight-year history of hem odialysis and a one-year history of acute attacks of neck pain, plain radio graphs showed narrowing of multiple cervical disks and a cyst in the C6 bod y. Discussion. the prevalence of DSA has been estimated at 18 to 48% after ten years on hemodialysis, The cervical spine is the segment most often inv olved, Although many patients remain asymptomatic, severe neurologic compli cations can occur. Factors thought to be involved in the genesis of DSA inc lude hyperparathyroidism, apatite crystal deposition, and beta 2microglobul in amyloid deposition.