Cervical fixation in the pediatric patient: our experience

The surgical management of cervical instability in children is a challenging issue. Although the indications for internal fixation are similar to those for adults, accurate pre-surgery study and sharp surgical techniques are necessary because of the size of such patients’ anatomy, their peculiar tissue biology and the wide spectrum of diseases requiring cervical fusion. Our case study is made up of 31 patients, 15 male and 16 female, with an average age of 7 years and 6 months (2 years and 6 months to 18 years) who underwent cervical fusion for instability. Their physical condition presented various different pathologies ranging from congenital deformity, systemic skeletal disease, tumors, trauma, post-surgery instability. We performed occipito-cervical fusion in 11 cases, 5 of which involved stabilization at the cranium–vertebral junction. We used instrumentation in 13 cases (3 sublaminar wiring, 10 rigid adult instrumentation). We used rigid adult instrumentation in three patients under 10 years of age, treated by rod, occipital screws and sublaminar hook instrumentation in steel C0–C2 (9-year-old male, affected by os odontoideum in Down’s syndrome; male of 7 years and 10 months, affected by os odontoideum in Down’s syndrome; female of 4 years and 6 months with occipito-cervical stenosis and C0–C2 instability in Hurler’s syndrome). We operated on two patients under 3 years of age, using sublaminar wiring with bone precursors and allograft at level C0–C2 (one of these was a 30-month-old male with post-traumatic instability C0–C2, while the other was a 17-month-old male with C0–C2 instability in Larsen’s syndrome). The average follow-up age was 7 years and 1 month (between 1 and 18 years). Cervical fusion was assessed by X-ray examinations at 4th and 12th weeks and at 6th and 12th months after surgery. Where implants could allow, RMN examination was performed at 1st month after surgery. In the other cases, in which implants do not allow RMN to be performed, CT scan and standard X-rays were carried out, and new X-rays were performed every other year. We experienced two cases of sublaminar wiring rupture without impairment of bone fusion. No patient suffered major complications (infection and osteomyelitis, rigid instrumentation mobilization, incomplete fusion with instability, neurologic impairment, insufficient cervical spine range of movement to cope with everyday life activities, cervical pain). Even though most authors still indicate that rigid instrumentation should be performed in cases over 10 years of age and sublaminar wiring in cases over 3 years of age, our findings demonstrate that this age limit can be lowered. We have treated children under 10 years of age by rigid adult instrumentation and under 36 months of age by wiring. The anatomic size of the patient is the most important factor in determining the use of instrument arthrodesis to treat pediatric cervical spine instability. Although not easy, it is possible and preferable in many cases to adapt fixation to child cervical spine even in very young patients.     

Differential treatment in acute upper cervical spine injuries: a critical review of a single-institution series

BACKGROUND: A single-institution series of injuries of the upper cervical spine are analyzed retrospectively and the literature relevant to the topic is reviewed. METHODS: Seventy patients (34 female, 36 male, mean age 47 years) were admitted during a 5-year period for injuries of the upper cervical spine. Sixty-five were followed for a mean time of 18 months. Three isolated ligamentous instabilities, 6 isolated C1 fractures, 3 complex C2 fractures, 10 combined C1/C2, and 48 C2 fractures (17 hangman's, 31 odontoid) were diagnosed. Twenty-nine patients were treated conservatively and for 41 patients surgery was the primary treatment. Twenty-three ventral odontoid screw fixations, 8 ventral platings and 10 dorsal stabilizations were performed. Stability was evaluated using flexion-extension radiography. Pain levels and neurological outcome were assessed. RESULTS: Operative mortality and neurological morbidity were 0%. Two wound infections and 3 instabilities (17%) in odontoid Type II fractures primarily treated with ventral odontoid screw fixation needed dorsal restabilization. During follow-up examinations the neurological status of three patients was improved. In 62 patients preoperative status was attained. Six patients evaluated their pain as severe, two as disabling. CONCLUSIONS: Candidates for surgery as the primary treatment include those with isolated ligamentous instabilities, Type III hangman's fractures and Type II odontoid fractures with dislocation more than 5 mm. In combined C1/C2 fractures the axis fracture dictates the treatment strategy. Patients who undergo dorsal procedures and have involvement of C1 have a greater chance of developing persistent pain.     

Wiring techniques of the posterior cervical spine for the treatment of trauma

Surgical stabilization of the cervical spine for maintaining reduction and facilitating fusion following trauma may be accomplished by wiring the dorsal elements together. Twenty gauge (0.8 mm) 316L stainless steel surgical wire is the most convenient size to use. Meticulous atraumatic technique is necessary to reduce and fix the unstable spine in order to prevent damage to the spinal cord. Multiple wiring techniques of the upper and lower cervical spine are described and demonstrated, noting the advantages and disadvantages of each.     

Palliative Occipito-Cervical Stabilization in Patients with Malignant Tumors of the Occipito-Cervical Junction and the Upper Cervical Spine

Summary. Summary.   Background: Occipital-cervical stability may be impaired in patients with primary malignant or metastatic tumors of the cranio-cervical junction and the upper cervical spine. The purpose of this study was to evaluate occipital-cervical fixation with prebended titanium-loops and sublaminar wiring in order to achieve a rigid and safe stabilisation of the occipito-cervical region in this group of patients.   Method: 20 patients with severe impairment of occipito-cervical stability due to primary malignant or metastatic cervical bone involvement were included in this study. For palliation of symptoms, resulting from destructive instability, a stabilization procedure using Ransford Loops with sublaminar cable fixation was used in these patients as a palliative therapeutic concept.   Findings: Pain which was the major symptom in all patients treated, showed good and immediate response to the stabilization procedures. All 20 patients were either pain free or had good improvement with less intake of analgesic drugs. Signs of spinal cord compression like spasticity and quadraparesis were less likely to improve after surgery. However in 3 of 5 patients neurological function improved after surgery whereas in 2 patients no improvement was achieved.   Interpretation: In all patients with impaired occipito-cervical stability due to primary malignant or metastatic tumors of the occipito-cervical junction and the upper cervical spine, immediate stabilization resulting in an improvement of pain was achieved. Occipito-cervical stabilization using contoured Ransford loops is a promising palliative therapeutic concept in this group of patients. Published online August 12, 2002     

Cervical fixation in the pediatric patient: our experience

The surgical management of cervical instability in children is a challenging issue. Although the indications for internal fixation are similar to those for adults, accurate pre-surgery study and sharp surgical techniques are necessary because of the size of such patients’ anatomy, their peculiar tissue biology and the wide spectrum of diseases requiring cervical fusion. Our case study is made up of 31 patients, 15 male and 16 female, with an average age of 7 years and 6 months (2 years and 6 months to 18 years) who underwent cervical fusion for instability. Their physical condition presented various different pathologies ranging from congenital deformity, systemic skeletal disease, tumors, trauma, post-surgery instability. We performed occipito-cervical fusion in 11 cases, 5 of which involved stabilization at the cranium–vertebral junction. We used instrumentation in 13 cases (3 sublaminar wiring, 10 rigid adult instrumentation). We used rigid adult instrumentation in three patients under 10 years of age, treated by rod, occipital screws and sublaminar hook instrumentation in steel C0–C2 (9-year-old male, affected by os odontoideum in Down’s syndrome; male of 7 years and 10 months, affected by os odontoideum in Down’s syndrome; female of 4 years and 6 months with occipito-cervical stenosis and C0–C2 instability in Hurler’s syndrome). We operated on two patients under 3 years of age, using sublaminar wiring with bone precursors and allograft at level C0–C2 (one of these was a 30-month-old male with post-traumatic instability C0–C2, while the other was a 17-month-old male with C0–C2 instability in Larsen’s syndrome). The average follow-up age was 7 years and 1 month (between 1 and 18 years). Cervical fusion was assessed by X-ray examinations at 4th and 12th weeks and at 6th and 12th months after surgery. Where implants could allow, RMN examination was performed at 1st month after surgery. In the other cases, in which implants do not allow RMN to be performed, CT scan and standard X-rays were carried out, and new X-rays were performed every other year. We experienced two cases of sublaminar wiring rupture without impairment of bone fusion. No patient suffered major complications (infection and osteomyelitis, rigid instrumentation mobilization, incomplete fusion with instability, neurologic impairment, insufficient cervical spine range of movement to cope with everyday life activities, cervical pain). Even though most authors still indicate that rigid instrumentation should be performed in cases over 10 years of age and sublaminar wiring in cases over 3 years of age, our findings demonstrate that this age limit can be lowered. We have treated children under 10 years of age by rigid adult instrumentation and under 36 months of age by wiring. The anatomic size of the patient is the most important factor in determining the use of instrument arthrodesis to treat pediatric cervical spine instability. Although not easy, it is possible and preferable in many cases to adapt fixation to child cervical spine even in very young patients.

     

Evaluation of morbidity,mortality and outcome following cervical spine injuries in elderly patients

We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit. Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.     

Comparative experimental biomechanical study of different types of stabilization methods of the lower cervical spine

In a comparative experimental biodynamic study using thirty-two human cervical spines of cadavers the primary stabilization effect of different types of spondylodesis was examined.Whereas in flexion stress all methods showed a sufficient stability, the rotation tests proved, that in case of a dorsal instability of the lower cervical spine, posterior interlaminar wiring or anterior plate stabilization showed no reliable stabilization effect.However, the compression clamps by Roosen and Trauschel as well as the hook-plates by Magerl are suitable dorsal stabilization methods with excellent rotation stability.In case of dorsal instability of the lower cervical spine a posterior spondylodesis is necessary and sufficient.     

Posterior Fusion in Patients with Trauma, Instability, and Tumor of the Cervical Spine

Trauma, instabilities and tumors of the cervical spine are treated with established methods of surgery. Therefore, anterior fusion is considered to be a standardized procedure for the lower cervical spine, while posterior and anterior instrumentation facilitates stabilization of the upper cervical spine. However, special situations that particularly require posterior instrumentation in traumatic lesions, tumor or other kinds of instabilities arise again and again. Neurological deficit symptoms, bone quality and related diseases fundamentally lead to a decision of posterior access and fusion. Different pathologies and corresponding reasons for posterior surgical interventions on the cervical spine are described in this paper and discussed using the current literature.     

Posterior transpedicular corpectomy for malignant cervical spine tumors

The goal of this study was to assess surgical clinical and radiographic outcomes of using a posterior transpedicular approach (posterolateral) for ventral malignant tumors of the cervical spine. Access to ventral lesions of the cervical spine can be challenging in patients with malignant tumors. Anterior approaches are the gold standard for ventral pathology in the cervical spine, however, there are cases, where a posterior approach is indicated due to multilevel disease, previous radiation, swallowing difficulty with difficulty in retraction of trachea and esophagus, and in cases where circumferential fusion cannot be done due to patients’ poor medical condition. A single approach could provide spinal stabilization and removal of tumor. Eight cases of ventral cervical spine malignant tumors (7 metastatic and 1 chordoma) underwent corpectomy through a posterior transpedicular (posterolateral) approach. Tumors involved C2 (5), C3 (1), C5 (1), and C7 (1). Six cases had anterior reconstruction and three column fusion, and two cases had posterior fusion alone. Gross total resection was achieved in all cases. No hardware failure or worsening of neurological condition was seen (4 patient were neurologically intact and remained intact after surgery and 4 patients improved in their Frankel grade). Pain improved in all patients, mean visual analog scale preoperative was 86 and improved to 22 after surgery. In two patients the vertebral artery was ligated without sequelae. We conclude that cervical spine transpedicular (posterolateral) approach is useful in cases where an anterior approach or a circumferential approach is not an option. It avoids the morbidity of anterior transcervical, transternal, and transoral procedures while providing decompression of neural elements and allowing three column stabilization when needed.     

Surgical procedures on the cervical spine in polyarthritis.

Summary Patients with rheumatoid arthritis suffer frequently from instabilities and deformities of the cervical spine which require surgical treatment. The most frequent indication for surgery represents the transverse atlantoaxial instability. As long the atlantoaxial instability remains reducible in extension a limited posterior exposure and screw fixation is adequate. Only situations with fixed dislocations and signs of myelopathy require anterior transoral decompression with simultaneous occipitocervical fusion. In the lower cervical spine, kyphotic deformities require anterior decompression and posterior stabilization in the case of electrophysiologically confirmed neurological deficits. A combined procedure with anterior vertebrectomy and decompression and posterior plate fixation is indicated since the poor bone quality rarely allows anterior stable fixation.      

Tumoren und Metastasen an der Wirbelsäule

Metastases in the spine make up the largest proportion of the total number of spinal tumors. Primary bone tumors are very rare and represent only a marginal proportion of all primary malignant tumors. Tumors such as breast, renal cell, prostate and lung cancer are most frequently described, with the peak age for the occurrence of spinal metastases between the ages of 40–65 years. They are mostly found in the thoracic, followed by the lumbar spine and most rarely in the cervical spine. Pain is usually the first symptom described by tumor patients caused by instabilities with osteolysis, pathological fractures, and neurological function failures. Pain reduction, stability and avoiding progressive neurological deficits must be the aim of surgical therapy in patients with advanced tumor growth.     

Traumatic occipitoatlantal dislocation

BACKGROUND: Traumatic occipitoatlantal dislocation (OAD) is a severe ligamentous injury resulting in instantaneous death or severe neurological deficit. However, survivors of OAD, both short and long term, have been increasingly reported; this may be because of improved prehospital care, more rapid transportation, a high index of suspicion, and new radiological techniques. METHODS: The medical records and film of three patients who had traumatic OAD were retrospectively reviewed. Diagnosis was made by lateral cervical spine radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Treatment consisted of early respiratory support and subsequent posterior surgical fusion. RESULTS: The three survivors of traumatic OAD represent 3.1% of all cervical spine injuries in our service. Two were children and the other was a 64-year-old man, all of whom suffered from severe neurological deficits. Lateral cervical spine radiographs led to the diagnosis of OAD. Two were longitudinal, and one was anterior. Two patients died within 2 weeks after injury. The remaining patient, who had anterior OAD, survived longer, which allowed posterior fusion with a U-shape Steinman pin and wiring to be performed. However, she died 5 months after injury because of septicemia. CONCLUSION: Early recognition and treatment may improve the outcome of this injury. Treatment consists of early respiratory support and subsequent surgical fusion.     

Cervical spinal stenosis and sports-related cervical cord neurapraxia in children.

STUDY DESIGN: Congenital spinal stenosis has been demonstrated to contribute to cervical cord neurapraxia after cervical spinal cord injury in adult athletes. A sagittal canal diameter <14 mm and/or a Torg ratio (sagittal diameter of the spinal canal: midcervical sagittal vertebral body diameter) of <0.8 are indicative of significant cervical spinal stenosis. Although sports-related cervical spine injuries are common in children, the role of congenital cervical stenosis in the etiology of these injuries remains unclear. OBJECTIVES: The authors measured the sagittal canal diameter and the Torg ratio in children presenting with cervical cord neurapraxia resulting from sports-related cervical spinal cord injuries to determine the presence of congenital spinal stenosis. METHODS: A total of 13 children (9 male, 4 female) presented with cervical cord neurapraxia after a sports-related cervical spinal cord injury. Age ranged from 7 to 15 years (mean +/- SD, 11.5 +/- 2.7 years). The sports involved were football (n = 4), wrestling (n = 2), hockey (n = 2), and soccer, gymnastics, baseball, kickball, and pogosticking (n = 1 each). Lateral cervical spine radiographs were used to determine the sagittal canal diameter and the Torg ratio at C4. RESULTS: The sagittal canal diameter (mean +/- SD, 17.58 +/- 1.63 mm) and the Torg ratio (mean +/- SD, 1.20 +/- 0.24) were normal in all of these children. CONCLUSION: Using the sagittal canal diameter and the Torg ratio as a measurement of congenital spinal stenosis, the authors did not find evidence of congenital cervical spinal stenosis in a group of children with sports-related cervical spinal cord neurapraxia. The occurrence of cervical cord neurapraxia in pediatric patients can be attributed to the mobility of the pediatric spine rather than to congenital cervical spinal stenosis.     

小儿下颈椎稳定性的外科重建

目的　探讨因创伤、结核或肿瘤引起的下颈椎不稳定的重建方法。方法　针对 8例年龄 2～ 7岁 ,平均4 .1岁的患儿行前路减压 ,大块髂骨植骨 ;后路棘突钢丝内固定 ,植骨融合术。结果　术后随访 6个月～ 4年 3个月 ,脊髓神经功能完全恢复 3例 ,部分恢复 4例 ,1例死于并发肺部感染。植骨完全融合 5例 ,处于融合阶段 2例。结论　采用前路减压加大块髂骨植骨 ,后路棘突钢丝内固定融合术 ,能较好地重建小儿下颈椎稳定性     

Simultaneous noncontiguous cervical spine injuries in a pediatric patient: case report

OBJECTIVE AND IMPORTANCE: Noncontiguous traumatic injuries of the cervical spine in children are rare. We present the case of a child who simultaneously sustained a separation of the odontoid synchondrosis and a C6-C7 dislocation with a complete spinal cord injury. The management of simultaneous cervical spine injuries is discussed. CLINICAL PRESENTATION: A boy aged 4 years and 2 months was a restrained back-seat passenger involved in a head-on motor vehicle accident. The patient lacked neurological function below C7. Imaging studies revealed a separation of the odontoid synchondrosis as well as a traumatic dislocation of the spine at C6-C7. INTERVENTION: The patient was placed in a halo vest shortly after admission. Four days after his injury, he underwent a posterior wiring and fusion of C6 to C7. As the C6-C7 dislocation was reduced by posterior element wiring, intraoperative x-rays showed a gradual increase in the subluxation of C1 on C2. This increase in C1-C2 subluxation required intraoperative repositioning of the halo crown on the ventral halo vest posts to maintain acceptable C1-C2 alignment. Postoperatively, ideal alignment of the odontoid peg on the body of C2 could not be achieved by halo adjustments alone. The patient required a custom-made posterior neck cushion attached to the halo vest to maintain cervical lordosis and good alignment of the odontoid peg on the body of C2. CONCLUSION: Simultaneous traumatic cervical spine injuries in pediatric patients are rare. The intraoperative reduction of one spine injury can affect the alignment at the location of the second injury. In this case, a custom adjustment of the halo vest improved the alignment of the odontoid peg on the body of C2.     

Treatment problems in unilateral locked facet syndrome of the cervical spine

Summary In a retrospective study of 22 patients with unilateral locked facet syndrome of the cervical spine, diagnostic and treatment problems were analysed. Diagnosis was delayed in ten patients; in two-thirds of the patients minor or major therapeutic problems were encountered. The treatment protocol advised manipulative reduction and-before 1986-posterior fusion by bone blocks and interspinous wiring; after 1986 ventral intercorporeal fusion by plates was recommended. Closed reduction manoeuvres risk dislocation of intervertebral discs, overdistraction of the spinal cord or injury to the vertebral artery. Unreduced and unfused dislocations are likely to develop chronic instability. Dorsal wiring is an inadequate form of stabilization and ventral plates or dorsal hooks are preferred. To prevent treatment problems a treatment protocol is proposed according to which open reduction following anterior discectomy, operative decompression of endangered nerve roots and stable one-level fusion is done. In non-acute injuries neural structures are decompressed; posterior fusion is done without attempts at reduction.     

Surgical stabilization of the cervical spine. A comparative analysis of anterior and posterior spine fusions

Two hundred twenty-two cervical spine stabilization procedures in 212 patients are reviewed. In 114 posterior cervical fusions, 88 anterior fusions, and ten combined procedures, no deaths occurred. Surgical complication rates were similar, but more severe complications were noted with anterior cervical fusions, including tracheoesophageal problems and transient neurologic loss. Six cases of graft dislodgement requiring reoperation also occurred. In long-term follow-up evaluations, 36 anterior fusion patients developed progressive kyphotic deformity averaging 22 degrees between surgery and the time solid fusion was obtained. Degenerative changes above and below the fusion mass were detected in 36 of 59 patients treated by anterior surgery. Posterior cervical fusion patients were noted to have no significant late change in alignment, and degenerative changes were infrequent. However, 73 of 98 patients had significant extension of fusion mass beyond the originally intended levels of stabilization. Because anterior cervical spine fusion was associated with significant complications of graft dislodgement and tracheoesophageal trauma, as well as postsurgical progressive deformity, the authors recommend posterior wiring and fusion as the procedure of choice to treat cervical spine instability and permit halo-free postsurgical rehabilitation. When anterior neural decompression and fusion is necessary, concomitant posterior wiring and fusion or halo vest immobilization may be necessary to maintain reduction and prevent kyphotic angulation, because posterior ligamentous disruption is not always grossly evident on radiographic examination.     

The use of anterior Caspar plate fixation in acute cervical spine injury

Optimal management of cervical cord injury in the presence of documented instability and/or compression of neural elements remains a controversial topic. Surgery and internal stabilization of cervical spine fracture/dislocations are effective and well accepted, but controversy exists on the relative merits of the anterior versus the posterior approach as well as the optimal timing of surgical intervention. We report our experience with the Caspar technique and instrumentation for anterior stabilization in 54 patients for acute cervical spine injury. Our series consists of 38 male and 16 female patients whose ages ranged from 16 to 68 years, with a mean age of 29.2 years. Thirty-two of these patients had complete neurological sensory/motor deficits at the time of presentation, eight were neurologically intact, and 14 had preservation of some motor and sensory function. All 54 patients had radiographic evidence of posterior instability as well as anterior disruption of either a vertebral body or intervertebral disk. We found that "early" intervention (less than 24 hours after injury) was performed frequently in the neurologically compromised patients. Twelve of the 22 patients undergoing surgery less than 24 hours after admission regained significant neurological function, with 13 of 22 developing postoperative complications. In the "delayed" group (surgery more than 24 hours after injury, mean 14.3 days), 14 patients experienced postoperative complications, with 15 of 24 demonstrating neurological improvement. The eight patients who were intact did uniformly well. There was no mortality during the follow-up. All 54 patients showed a solid fusion (clinically and radiologically) within 6 months of surgery. In two cases the plates had to be removed, without risking the fusion. Our experience suggests that although anterior cervical fusion and Caspar plating remain appropriate for patients with documented anterior compromise of the canal, it should not substitute for more traditional posterior stabilization procedures. Because this route has the potential for more serious complications, it should be reserved for the cases in which anterior decompression is deemed necessary or posterior fusion was unsuccessful. With appropriate selection of patients, no adverse effect of early surgery was demonstrated. In fact, neurologically compromised patients had the benefits of increased ease of patient care and early transfer to rehabilitation.     

Surgical treatment of cervical destructive spondyloarthropathy (DSA)

STUDY DESIGN: Sixteen patients with hemodialysis-associated cervical spine disorders underwent surgical treatment. After analysis of the surgical results, the optimum surgical procedures for these disorders were discussed. OBJECTIVE: To evaluate the surgical results of cervical spine disorders associated with long-term hemodialysis and to propose the optimum surgical procedures for successful outcomes. SUMMARY OF BACKGROUND DATA: There have been few reports regarding surgical results of hemodialysis-related cervical spine disorders. Surgical treatment for this disorder is still challenging. METHODS: Sixteen patients with hemodialysis-associated cervical spine disorders were treated surgically. Duration of hemodialysis ranged from 8 to 27 years (average, 17 years). Before surgery, 14 patients showed severe cervical myelopathy, and the other 2 had radiculopathy in the upper extremities. Ten patients with marked destructive changes underwent circumferential reconstructive surgery involving pedicle screw fixation, anterior strut bone grafting, and posterior and/or anterior decompression. Two patients with cervical radiculopathy underwent posterior nerve root decompression by foraminotomy and fusion by pedicle screw fixation or spinous process wiring. The remaining four patients without spinal instability underwent posterior decompression by open-door laminoplasty. RESULTS: Two patients died during follow-up. Follow-up periods in the surviving 14 patients ranged from 25 months to 92 months (average, 53 months). Marked neurologic recovery was obtained in all patients after surgery. Successful spinal fusion was obtained in all patients except one who underwent posterior fusion by spinous process wiring. Progressive destructive changes with significant instability at the adjacent mobile segments were observed in two patients who underwent circumferential fusion with a pedicle screw system more than 2 years after the initial surgery. CONCLUSIONS: The pedicle screw system achieved a high fusion rate in reconstructive surgery of cervical destructive spondyloarthropathy, even in the presence of severe bone fragility.