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Postoperative cervical spine CT showing hardware failure at C3 with anterior shift of the allograft.
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Figure 11: Postoperative cervical spine CT showing hardware failure at C3 with anterior shift of the allograft.

Mentions: Based on these findings and because upper extremity weakness was progressing, the patient had anterior C4 and C5 corpectomy and fusion using iliac crest autograft and anterior stabilization with dynamic plate and screws from C3 to C6 (Fig. 10). In the immediate postoperative period, he noted significant improvement of neck pain but radiculopathy symptoms did not improve. Then, on postoperative day 2, the patient experienced acute, severe neck pain recurrence while ambulating. Repeat cervical spine CT scan showed hardware failure at C3 with anterior shift of the autograft (Fig. 11).

Surgical Management of Cervical Spondyloarthropathy in Hemodialysis Patients

Spinos P, Matzaroglou C, Partheni M, Deli A, Karanikolas M, Konstantinou D - Open Orthop J (2010)

Bottom Line: The occasional presence of noncontiguous or "skip lesions" adds an additional level of complexity to surgical management, because decompression and fusion in an isolated segment of neural compression can worsen spine deformity by applying increased stress to adjacent cervical spine segments.Because symptoms recurred due to hardware failure, both patients required posterior spine fusion as well.In retrospect, because of the hardware failure, both of these patients might have benefited from a circumferential (combined anterior and posterior) cervical spine reconstruction as their initial treatment.

Affiliation: Department of Neurosurgery, Patras University Hospital, Rion, Greece.

ABSTRACT
Dialysis-related spondyloarthropathy is a rare cause of spinal deformity and cervical myelopathy. Optimal management of cervical spine spondyloarthropathy often requires circumferential reconstructive surgery, because affected patients typically have both the anterior column and the facet joints compromised. The occasional presence of noncontiguous or "skip lesions" adds an additional level of complexity to surgical management, because decompression and fusion in an isolated segment of neural compression can worsen spine deformity by applying increased stress to adjacent cervical spine segments. We report two cases of hemodialysis patients who presented with cervical myelopathy and initially had anterior cervical discectomy or corpectomy. Because symptoms recurred due to hardware failure, both patients required posterior spine fusion as well. In retrospect, because of the hardware failure, both of these patients might have benefited from a circumferential (combined anterior and posterior) cervical spine reconstruction as their initial treatment.

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