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Surgical Treatment for Atlanto-Occipital Subluxation due to Destructive Spondyloarthropathy in a Patient Undergoing Long-Term Hemodialysis.

Wada K, Murata Y, Kato Y - Asian Spine J (2015)

Bottom Line: DSA was also observed in the lower cervical spine.Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels.We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT
Destructive spondyloarthropathy (DSA) has been reported in patients undergoing long-term hemodialysis. Cervical spinal lesions, including those of the upper cervical spine, are reported to be some of the most common. To our knowledge, we report for the first time, a case of atlanto-occipital subluxation requiring surgical treatment due to severe myelopathy and nuchal pain in a patient undergoing long-term hemodialysis. The patient was a 66-year-old woman who had undergone hemodialysis for 40 years. She visited our hospital due to an acute progression of gait disturbance and severe nuchal pain. Computed tomography showed posterior subluxation of the atlanto-occipital joints. DSA was also observed in the lower cervical spine. Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels. We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty. We first recognized that the atlanto-occipital subluxation was caused by the extremely long-term, in this case, 40 years, hemodialysis.

No MeSH data available.


Related in: MedlinePlus

(A) Lateral radiography at 14 months postoperatively. (B) Sagittal computer tomography at 12 months shows a solid bony union between the occiput and bone graft.
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Figure 3: (A) Lateral radiography at 14 months postoperatively. (B) Sagittal computer tomography at 12 months shows a solid bony union between the occiput and bone graft.

Mentions: We performed posterior Oc-C7 fixation, C1 posterior arch resection, and C3-C7 laminoplasty. A block of iliac bone graft was placed between Oc and C2. Bone graft was also placed between C3 and C7. Postoperative radiography showed a good alignment of the cervical spine (Fig. 3A). A solid bone union, an expanded spinal canal, and reduction of the clivus (Fig. 3B) were observed on a postoperative CT 14 months after the surgery. Eighteen months after surgery, the patient's postoperative JOA score was 7 points and her nuchal pain had disappeared.


Surgical Treatment for Atlanto-Occipital Subluxation due to Destructive Spondyloarthropathy in a Patient Undergoing Long-Term Hemodialysis.

Wada K, Murata Y, Kato Y - Asian Spine J (2015)

(A) Lateral radiography at 14 months postoperatively. (B) Sagittal computer tomography at 12 months shows a solid bony union between the occiput and bone graft.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522456&req=5

Figure 3: (A) Lateral radiography at 14 months postoperatively. (B) Sagittal computer tomography at 12 months shows a solid bony union between the occiput and bone graft.
Mentions: We performed posterior Oc-C7 fixation, C1 posterior arch resection, and C3-C7 laminoplasty. A block of iliac bone graft was placed between Oc and C2. Bone graft was also placed between C3 and C7. Postoperative radiography showed a good alignment of the cervical spine (Fig. 3A). A solid bone union, an expanded spinal canal, and reduction of the clivus (Fig. 3B) were observed on a postoperative CT 14 months after the surgery. Eighteen months after surgery, the patient's postoperative JOA score was 7 points and her nuchal pain had disappeared.

Bottom Line: DSA was also observed in the lower cervical spine.Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels.We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Tokyo Women's Medical University, Tokyo, Japan.

ABSTRACT
Destructive spondyloarthropathy (DSA) has been reported in patients undergoing long-term hemodialysis. Cervical spinal lesions, including those of the upper cervical spine, are reported to be some of the most common. To our knowledge, we report for the first time, a case of atlanto-occipital subluxation requiring surgical treatment due to severe myelopathy and nuchal pain in a patient undergoing long-term hemodialysis. The patient was a 66-year-old woman who had undergone hemodialysis for 40 years. She visited our hospital due to an acute progression of gait disturbance and severe nuchal pain. Computed tomography showed posterior subluxation of the atlanto-occipital joints. DSA was also observed in the lower cervical spine. Magnetic resonance imaging showed spinal canal stenosis at both the upper and lower cervical levels. We performed Oc-C7 fixation, C1 laminectomy, and C3-C7 laminoplasty. We first recognized that the atlanto-occipital subluxation was caused by the extremely long-term, in this case, 40 years, hemodialysis.

No MeSH data available.


Related in: MedlinePlus