I. Imaging Findings

Based on the provided X-ray anteroposterior and lateral views, as well as CT sagittal images, the following key features are observed:

• There are prominent sclerotic bands at the superior and inferior endplates of the vertebral bodies, visible on X-ray as relatively high-density stripes.
• The central portion of the vertebral body exhibits relatively lower density compared to the sclerotic bands at the endplates, forming a “rail-like” striped appearance.
• There is no significant vertebral collapse or deformation, and no definitive pathological fracture is observed.
• No obvious paravertebral soft tissue masses or significant bone destruction are noted.

II. Potential Diagnoses

Based on the above imaging findings and the patient’s clinical background, possible diagnoses include:

1. Secondary Hyperparathyroidism (Renal Osteodystrophy)
   The patient has chronic renal failure and is receiving dialysis. The retention of serum phosphate and decreased serum calcium can stimulate the parathyroid glands, resulting in secondary hypersecretion of parathyroid hormone. In this scenario, sclerotic bands may appear at the superior and inferior vertebral endplates, producing the characteristic “rugger jersey spine” radiographic finding.
2. Osteopetrosis
   Osteopetrosis can exhibit sclerotic bands in the vertebral bodies, but typically the interface between the sclerotic band and the central lucent area is sharper, presenting a “sandwich vertebra” appearance, which does not entirely match the endplate sclerosis in this case.
3. Paget’s Disease
   Paget’s disease can manifest as bone overgrowth and thickening of the cortical margins within the vertebrae. Typically, vertebrae may show a “picture frame vertebra” appearance, which is not fully consistent with “rugger jersey spine,” and it is often accompanied by an increase in vertebral size or morphological changes.

III. Final Diagnosis

Combining the patient’s existing clinical data (chronic renal failure, dialysis treatment, changes in biochemical parameters) with the imaging findings, the “rugger jersey spine” sign strongly suggests renal osteodystrophy, i.e., spinal changes caused by secondary hyperparathyroidism. Further confirmation can be obtained by measuring serum parathyroid hormone (PTH), calcium, phosphorus, and vitamin D levels.

IV. Treatment and Rehabilitation Plan

Based on the “rugger jersey spine” caused by secondary hyperparathyroidism, the key points of treatment and rehabilitation include:

• Medications and Conservative Treatment
  • Optimize renal replacement therapy: ensure regular dialysis and control serum phosphate, serum calcium, and PTH levels.
  • Use phosphate binders, active vitamin D preparations, or calcium supplements to correct metabolic disturbances.
  • Regularly monitor PTH, calcium, and phosphorus levels, and adjust medications accordingly or consider surgical intervention (e.g., parathyroidectomy) when necessary.
• Principles of Exercise Rehabilitation
  • Initial Phase:
    • It is recommended to engage in low-impact aerobic exercises (such as using a stationary bike, slow walking, or gentle calisthenics in the intervals between dialysis sessions) 3–5 times per week, each session lasting 15–20 minutes.
    • The exercise intensity should be maintained at a level of “light to somewhat hard” (RPE 11–13), avoiding excessive fatigue.
  • Intermediate Phase:
    • Gradually increase exercise duration to 30 minutes, raise the frequency to 4–5 times per week, and incorporate mild resistance training (e.g., elastic band stretches, core stability exercises).
    • Continue to monitor bone-joint and cardiopulmonary function, and adjust exercise intensity accordingly.
  • Long-term Consolidation Phase:
    • Maintain or slightly increase exercise intensity (RPE 12–14) and consider adding periodic, low-intensity strength training (e.g., light dumbbell lifts, seated rowing machine, etc.).
    • Continue regular follow-up examinations to monitor bone density and parathyroid function changes.
  • Safety Precautions
    • In the presence of increased fracture risk, avoid intense twisting, jumping, or excessive loading.
    • Pay attention to cardiopulmonary function; if chest tightness, significant shortness of breath, or dizziness occurs, discontinue exercise promptly and seek medical advice.

Gradually adjust the Frequency, Intensity, Time, Type, and Progression of exercise according to the patient’s individual condition and dialysis schedule to develop a personalized training program.

Disclaimer: The above report is intended solely as a reference analysis based on the existing information and does not replace in-person consultations or professional medical advice. Please integrate the patient’s actual situation and consult a professional physician before implementing a specific treatment plan.