Clinical outcomes after posterior cervical decompression and fusion surgery for destructive spondyloarthropathy in patients undergoing long-term hemodialysis: A matched case-control study

Abstract

Background: Cervical destructive spondyloarthropathy (DSA) often leads to cervical myelopathy in long-term hemodialysis patients. However, the surgical outcomes after instrumented fusion surgery for cervical DSA are still unclear. The objective of this study was to investigate the clinical outcomes of cervical DSA in comparison with a control group.

Materials and methods: A consecutive series of 20 undergoing long-term hemodialysis patients who underwent instrumented fusion surgery for cervical DSA between 2010 and 2016 were included in this study (DSA group). The mean age at surgery was 65 years, and there were 11 men and 9 women. The average length of hemodialysis was 23 years. The age- and sex-matched control group consisted of 20 patients (degenerative conditions). The Japanese Orthopedic Association (JOA) score, recovery rate, complications, and loss of correction of fused level were compared between the groups.

Results: Two of the 20 patients died due to perioperative complications. More than 1 year of follow-up data after surgery was available for 18 patients. The mean JOA score significantly increased from 5.4 before surgery to 9.7 at 1 year after surgery and 8.3 at the final follow-up (mean: 33.2 ± 21.3 months, P = 0.019). There were no significant differences in the mean recovery rate (41% vs. 37%, P = 0.44) between the DSA group and control group. Loss of correction of more than 5°was significantly higher in the DSA group (44% vs. 10%, P = 0.027). The rate of pseudarthrosis (17% vs. 5%, P = 0.328) and adjacent segment disease (22% vs. 10%, P = 0.17) tended to be higher in the DSA group.

Discussion: The clinical outcomes showed significant recovery in both groups. Therefore, posterior cervical decompression and fusion surgery was effective for treating cervical DSA.