Renal osteodystrophy of the cervical spine: Neurosurgical implications

Somnath Nair, John Vender, Thomas M. McCormack, Perry Black

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

RENAL OSTEODYSTROPHY DESCRIBES the changes in bone physiology seen in renal failure. Traditionally, these changes resulted in mild neurological sequelae that were effectively managed medically. Despite the often severe destruction seen on x-ray, surgical therapy has not been reported extensively. With increasing numbers of long-term hemodialysis survivors, 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 sequela of hemodialysis patients; therefore, this diagnosis must be considered. Although renal osteodystrophy can be seen throughout the spine, reports of significant cervical spine involvement are uncommon. We present our experience with six cases of renal osteodystrophy of the cervical spine requiring surgical intervention for instability or cord compression. Osteomyelitis was present in two of the patients. The pathophysiology and radiographic characteristics of renal osteodystrophy and the incidence of osteomyelitis are discussed. Fusion techniques, including the use of anterior and posterior internal and external stabilization, are presented. These patients represent a therapeutic challenge for the neurosurgeon, given the underlying bone pathology.

Original languageEnglish (US)
Pages (from-to)349-355
Number of pages7
JournalNeurosurgery
Volume33
Issue number3
DOIs
Publication statusPublished - Sep 1993
Externally publishedYes

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Keywords

  • Erosive spondyloarthropathy
  • Hemodialysis
  • Osteomyelitis
  • Renal osteodystrophy
  • Spinal instability

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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