Clinical Outcomes Following Cervical Fusion in Patients with Dialysis-Related Spondyloarthropathy: A Systematic Review.

Abstract

Background: Dialysis-related spondyloarthropathy (DRSA) is a rare but serious spinal pathology among patients on long-term dialysis, most commonly affecting the cervical spine. DRSA often requires surgical intervention by means of fusion when accompanied by substantial neurological and/or clinical symptoms, although available data are limited. This systematic review investigates the collated outcomes after cervical fusion in patients with DRSA to inform surgical decision-making and improve dialysis-related spine surgery care.

Methods: A pre-registered systematic review, conducted through June 20, 2025, searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, and Web of Science for studies with outcome data on patients with DRSA undergoing cervical fusion. To determine study quality, the Methodological Index for Non-Randomized Studies scale was applied, and outcome certainty grading was performed. Demographics, operative details, functional recovery, and complications were extracted. Descriptive statistics were used for narrative evidence synthesis.

Results: Nine retrospective observational studies (six "moderate", three "low" quality) with "very low" outcome certainty were included out of 91 retrieved.

Patients: Patients (n=88; 39.8% female; frequency-weighted mean [FWM] age=60.0±8.3 years; follow-up=50.3±42.3 months) were on dialysis for a FWM of 17.1±7.0 years, with 3.2±1.4 intervertebral levels fused (67.0% posterior-utilizing approach). Most studies (88.9%) reported that at least 80% of their cohort experienced improvements in symptoms after fusion, and the FWM postoperative Japanese Orthopaedic Association score improvement was 4.5. Pseudoarthrosis occurred at a pooled rate of 15.0%, and total complications occurred at a pooled rate of 36.3%. Infections (16.1%) were the most common complication. Complication-related mortality was reported at a pooled rate of 9.1%.

Conclusions: Cervical fusion in patients with DRSA appears to provide considerable functional improvement, though concerns remain regarding complications and mortality. Future high-quality studies of greater outcome quality and certainty are warranted to further advance evidence-based surgical decision-making in this complex yet rapidly growing dialysis-reliant population.

Level of evidence: Level IV.