Outcomes of surgery for cervical spondylotic myelopathy in haemodialysis patients

Abstract

Introduction: Cervical spondylotic myelopathy in haemodialysis patients has been reported to have several complications. Destructive spondyloarthropathy is caused by amyloid deposition in the spine, leading to destructive changes and instability. Operations for this condition are challenging because of difficulties in perioperative management. The purpose of this study was to investigate the surgical outcomes of cervical laminoplasty alone and combined with posterior fusion for cervical spondylotic myelopathy in haemodialysis patients.

Methods: Among 23 haemodialysis patients with cervical spondyloarthropathy, 10 underwent laminoplasty alone (Group A) and 13 underwent laminoplasty with posterior fusion using a cervical pedicle screw (CPS) (Group B). The groups were statistically compared regarding C2/7 angle, local kyphosis angle, and clinical outcome (Japanese Orthopaedic Association [JOA] score and recovery rate) at pre-operation (pre) and follow-up (FU). Perioperative complications were also investigated in both groups.

Results: The JOA scores (pre/FU) were 7.9/10.4 points in Group A and 6.9/9.9 points in Group B, with average improvement rates of 35.5% in Group A and 44.3% in Group B. The pre/FU C2/7 angles were 10.9/13° in Group A and −2.6/1.6° in Group B. Local kyphosis was none (pre) in Group A and −14.6/−4.1° in Group B. The perioperative complications included two adjacent lesions and C5 paralysis in two cases; however, no deaths in the perioperative period were observed. These patients needed no revision surgery because they had no neurological symptoms.

Conclusion: In this study, the outcomes of posterior fusion surgeries for destructive spondyloarthropathy were acceptable without any catastrophic complications, even though the patients' preoperative myelopathic conditions were severe.

Haemodialysis (HD) patients have experienced prolongation of lifespan, and the number of these patients with destructive spondyloarthropathy (DS) is increasing. In this study, the outcomes of surgeries for DS were acceptable without any catastrophic complications, even though the patients' preoperative myelopathic conditions were severe. We were able to perform posterior fixation using a CPS with a supporting navigation technique and pedicle marker. The pedicle markers further improved the accuracy of CPS insertion and avoidance of vertebral artery (VA) injury using the navigation system.