SURGICAL-TREATMENT OF DESTRUCTIVE SPONDYLARTHROPATHY IN HEMODIALYSIS-PATIENTS - A REVIEW OF 10 INTERBODY FUSION PROCEDURES IN 8 HEMODIALYSIS-PATIENTS

Destructive spondyloarthropathy is common in long-term hemodialysis pa tients. We report the outcomes of ten interbody fusion procedures (8 a t the cervical spine and two at the lumbar spine) in eight hemodialysi s patients with spinal cord and/or nerve root compression. Duration of hemodialysis ranged from one to 26 years (mean 15 years). Each fusion procedure involved one to four intervertebral spaces, of which at lea st one exhibited marked instabiliby with vertebral slippage. The anter ior approach was used. After removal of the disc(s), a tricortical cor tico-iliac graft was implanted and screw-plate fixation was performed. A Minerva jacket was worn for 90 to 100 days. There were no deaths re lated to the arthrodesis procedure. One patient developed a deep vein thrombosis during the postoperative period. All the graft fusions were achieved within the expected time interval. One patient required earl y reoperation because of disruption of the fixation. At functional eva luation after six months to five years, patients were free of pain and had recovered normal neurological function. One patient required anot her arthrodesis procedure five years after the first because of mild p yramidal signs and instability at the C7-T1 intervertebral space under the previously grafted five-level segment. Our data demonstrate that interbody fusion yields satisfactory outcomes when used to treat destr uctive spinal lesions in hemodialysis patients. However, this method s hould be used only in patients with severe lesions responsible for neu rological compromise.