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Hemodialysis Spondyloarthropathy


KEY FACTS

Terminology

  • Destructive spondyloarthropathy

  • Discocentric destructive arthritis in patient on long-term hemodialysis

Imaging

  • Vertebral and endplate destruction in patient on long-term hemodialysis, ± vertebral collapse

    • Cervical, thoracic, or lumbar spine

    • Often involves multiple levels

  • Endplate destruction with sharply marginated erosions

  • Amorphous material in disc, spinal canal, &/or prevertebral soft tissues

    • Usually lower signal intensity than infection on T2WI, STIR

Top Differential Diagnoses

  • Infection

  • Neuropathic joint

  • Gout

  • Calcium pyrophosphate deposition disease

Pathology

  • 2 types of arthropathy associated with hemodialysis

    • Amyloid deposition: β-2 microglobulin

    • Crystal deposition: Hydroxyapatite

Clinical Issues

  • Indolent

  • May result in spinal instability

  • Back pain, radiculopathy, cord compression

  • Fusion for stabilization

Diagnostic Checklist

  • Specimen must be sent for crystal analysis in saline or ethanol; formalin dissolves crystals

  • History is key to making diagnosis

Coronal graphic shows 2 types of hemodialysis arthropathy: Crystal deposition and amyloid deposition , both of which may cause endplate erosions.

Lateral radiograph shows severe bone destruction centered at the C4-C5 disc with smaller, punched-out erosions at C5-C6 and C6-C7. This patient was on hemodialysis and had chronic, worsening neck pain and findings consistent with cord compression.

Sagittal T1WI MR shows severe bone destruction centered at the C4-C5 disc with smaller, punched-out erosions at C5-C6 and C6-C7. This patient was on hemodialysis and had chronic, worsening neck pain and findings consistent with cord compression. Soft tissue posteriorly could represent discs or crystal deposition.

Sagittal STIR MR of the same patient shows severe cord compression. Of note, discs and masses remain very low signal intensity, unlike pyogenic infection.

TERMINOLOGY

Synonyms

  • Destructive spondyloarthropathy (DSA)

Definitions

  • Discocentric destructive arthritis in patient on long-term hemodialysis

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