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

• Published in: Asian spine journal Vol. 9; no. 4; pp. 621 - 624
• Main Authors: Wada, Keiji, Murata, Yasuaki, Kato, Yoshiharu
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Spine Surgery 01.08.2015; Korean Spine Society; 대한척추외과학회
• Subjects: Amyloidosis; Atlanto-occipital subluxation; Calcification; Case Report; Central nervous system diseases; Computed tomography; Conflicts of interest; Cysts; Destructive spondyloarthropathy; Gait; Hemodialysis; Magnetic resonance imaging; Movement disorders; Orthopedics; Pain; Patients; Radiography; Skin & tissue grafts; Spinal cord; Spine (cervical); Spondyloarthropathy; Stenosis; Surgery; Tomography; 정형외과학; Destructive spondyloarthropathy; Atlanto-occipital subluxation; Hemodialysis
• ISSN: 1976-1902; 1976-7846
• DOI: 10.4184/asj.2015.9.4.621

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.