[Presentation of the 3-dimensional spongiosa structure of the spine in renal osteopathy after chronic hemodialysis].

Characteristic skeletal changes occur in patients with chronic renal insufficiency. The aim of this study was comprehensively to record bone volume changes in the spine, from C2 to L5, after a long history of hemodialysis. The spinal columns of nine autopsy cases who had undergone 4 to 15 years of dialysis were thoroughly examined. The age-related control group consisted of 26 autopsy cases with intact skeletons. A iliac crest biopsy facilitated a direct comparison of the diagnostic biopsy location and the spinal column. A newly developed preparation technique enables a combined two- and three-dimensional analysis to be made, so that in addition to the histologic image, the directly underlying three-dimensional structure can be analyzed. The spine deformity index (SDI), the bone volume (BV/TV), and the trabecular interconnection (TBPf) was quantitatively evaluated. The SDI shows vertebral fractures in renal osteodystrophy (ROD) types I and II in spite of a trabecular bone volume within normal limits. The trabecular bone volume shows a distribution throughout the spinal column familiar from the skeletally intact control group. The plateau-like curve line, decreasing from the cervical spine to the lumbar spine is, however, 5% lower in ROD. BV/TV values of 51.2% and 74.1% in the 2nd lumbar vertebra are clearly lower than in the corresponding iliac crest biopsy. Cases with a longer history of hemodialysis show higher BV/TV values irrespective of age and sex. Normal BV/TV does not mean physiological linking. Three-dimensional analysis in ROD shows, in comparison to the controls, a much stronger restructuring of the architecture than can be assumed from the two-dimensional histological sections.(ABSTRACT TRUNCATED AT 250 WORDS)