Kumar A, Leventhal M R, Freedman E L, Coburn J, Delamarter R
Department of Orthopaedic Surgery, University of Tennessee Campbell Clinic, Memphis, USA.
Spine (Phila Pa 1976). 1997 Mar 1;22(5):573-7; discussion 578. doi: 10.1097/00007632-199703010-00024.
Eleven patients with chronic renal failure and destructive spondyloarthropathy of the cervical spine were evaluated with plain radiographs, flexion-extension views, computed tomography myelogram, or magnetic resonance imaging to determine the results of surgical and nonsurgical treatment.
To determine if cervical spine fusion is an effective method of treatment for patients with chronic renal failure and destructive spondyloarthropathy.
Several reports have described the pathogenesis and appearance of this condition, but little has been reported about the orthopedic management of destructive spondyloarthropathy of the cervical spine.
Three patients had no spinal surgery, three patients had laminectomies alone, three patients had laminectomies with anterior fusions, and two patients had laminectomies with posterior fusions. Radiographs, computed tomography myelograms, and magnetic resonance images were evaluated to determine the results of treatment. Histologic examinations were performed in two patients.
Patients with laminectomy alone had no improvement in pain or neurologic function (one died in the immediate postoperative period), one of three patients with anterior fusions had some improvement (one died in the immediate postoperative period), and both of those patients with posterior fusions improved, although both died within a year of surgery from unrelated causes.
Even though the osteopenia present in patients with chronic renal failure tends to allow wire pull-out and makes internal fixation of the spine difficult, successful cervical spinal fusion can relieve pain and improve neurologic deficits in selected patients with chronic renal failure and destructive spondyloarthropathy, allowing them to remain more active for longer periods of time.
对11例患有慢性肾衰竭和颈椎破坏性脊柱关节病的患者进行了X线平片、屈伸位片、计算机断层扫描脊髓造影或磁共振成像检查，以确定手术和非手术治疗的结果。
确定颈椎融合术是否是治疗慢性肾衰竭和颈椎破坏性脊柱关节病患者的有效方法。
已有多篇报道描述了这种疾病的发病机制和表现，但关于颈椎破坏性脊柱关节病的骨科治疗报道较少。
3例患者未接受脊柱手术，3例患者仅行椎板切除术，3例患者行椎板切除并前路融合术，2例患者行椎板切除并后路融合术。通过评估X线片、计算机断层扫描脊髓造影和磁共振图像来确定治疗结果。对2例患者进行了组织学检查。
仅行椎板切除术的患者疼痛或神经功能无改善（1例在术后即刻死亡），3例行前路融合术的患者中有1例有一定改善（1例在术后即刻死亡），2例行后路融合术的患者均有改善，尽管两者均在术后1年内因无关原因死亡。
尽管慢性肾衰竭患者存在的骨质减少倾向于导致钢丝拔出并使脊柱内固定困难，但成功的颈椎融合术可以缓解部分慢性肾衰竭和颈椎破坏性脊柱关节病患者的疼痛并改善神经功能缺损，使他们能够在更长时间内保持更活跃的状态。
