Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients

A 63-year-old man with end-stage renal disease (ESRD) who had been undergoi ng hemodialysis for 18 years suffered persistent neck pain, progressive qua driparesis. and a deteriorating ataxic gait during the 6 months before admi ssion. A sudden onset of aggravating quadriparesis and an inability to ambu late occurred during his trip to Sydney, Australia, 1 week before this admi ssion. Vertebral tuberculosis osteomyelitis of the C5/6 segment was conside red and treated in a hospital there. Findings from cervical magnetic resona nce imaging (MRI; low signal intensity on both T1- and T2-weighted images) were diagnostic of destructive spondyloarthropathy (DSA) and distinguishabl e from spinal osteomyelitis preoperatively. Amyloid masses, mainly composed of B-2 microglobulin, filled in disc and paradiscal ligaments, with adjace nt endplate destruction by cytokine-mediated reactive inflammation, and app eared to be mostly related to the pathogenesis-of DSA, The cervical spine, especially C5/6, is the most common site of DSA. Spinal instability and neu rologic compression cause the clinical symptoms and signs. Adequate decompr ession and successful cervical fusion ensure the best therapeutic results.