Outcomes of Degenerative Lumbar Spine Surgery in Patients with Chronic Kidney Disease Undergoing Hemodialysis

JANG HAE DONG; Jae Chul Lee; 신병준; Hong, Sijohn; 안중현; Sung-Woo Choi; Deokwon Kang; 조형규

Study Design: Retrospective study. Objectives: To analyze the outcomes of degenerative lumbar spine surgery in patients undergoing hemodialysis due to chronic kidney disease (CKD). Summary of Literature Review: Patients who undergo hemodialysis due to chronic renal disease tend to exhibit accelerated changes in bone quality, deterioration of spinal stenosis, and accompanying neurological degeneration. The surgical treatment of chronic spinal diseases is also becoming more necessary with the increased lifespan of these patients. Materials and Methods: We reviewed the medical records and radiographs of patients with CKD undergoing hemodialysis who were followed-up for more than 1 year after posterior lumbar spinal surgery. We evaluated clinical, laboratory, and radiologic variables. For a comparative analysis, patients were classified into subgroups according to age (65 years old), duration of hemodialysis (10 years), and type of surgery (simple decompression or fusion). Results: We included 21 patients (5 men, 16 women) with a mean age of 66.2 years (range, 48-87 years). The mean duration of hemodialysis and follow-up was 18.9 years and 43 months, respectively. Decompressions with fusion were performed in 11 patients and simple decompressions in the other 10. The mean visual analog scale (VAS) of leg pain and the Oswestry Disability Index (ODI) significantly improved after surgery at time of the last follow-up; meanwhile, the mean VAS score for lower back pain did not show a statistically significant improvement. The postoperative ODI was correlated with age (correlation coefficient=0.71, p=0.006). In patients less than 65 years old, the ODI improvement was greater (p=0.035) than in those 65 years of age or older. There was no significant difference in the clinical outcomes according to the duration of hemodialysis. Complications were observed in 11 patients (52.4%, 7 in fusion and 4 in simple decompression), of which 2 cases were infections, and reoperations were performed in 5 patients. The union rate of the fusion cases at the 1-year follow-up was 81.8%. Conclusions: Appropriate spine surgery improved radicular pain and the ODI in patients with degenerative lumbar disease undergoing hemodialysis. However, postoperative complications were frequent and the improvement of clinical outcomes was minimal, especially in patients over 65 years of age and in those who underwent fusion. Therefore, the surgical treatment of patients with chronic renal disease undergoing hemodialysis requires adequate consideration of age and the duration of hemodialysis.

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* 2021년 이후 발행 논문의 참고문헌은 현재 구축 중입니다.

[journal] Okada H / 1999 / Does intensive perioperative dialysis improve the results of coronary artery bypass grafting in haemodialysed patients? / Nephrol Dial Transplant 14 : 771~775

[journal] Han I-H / 2009 / Spinal Surgery in Patients With End-Stage Renal Disease Undergoing Hemodialysis Therapy / Spine(Phila Pa 1976) 34 : 1990~1994

[journal] Chikuda H / 2012 / Mortality and Morbidity in Dialysis-Dependent Patients Undergoing Spinal Surgery / J Bone Jt Surg 94 : 433~438

[journal] Kazama JJ / 2013 / Uremic osteoporosis / Kidney Int Suppl 3 : 446~450

[journal] Erlichman M / 1996 / Bone densitometry: patients with end-stage renal disease / Health Technol Assess 8 : 1~27

[journal] Orzincolo C / 1991 / Course of radiologic changes in spondyloarthropathy caused by dialysis / Radiol Med (Torino) 81 : 228~233

[journal] Kessler M / 1992 / Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. The Co-operative Group on Dialysis-associated Arthropathy / Br J Rheumatol 31 : 157~162

[journal] Kuntz D / 1984 / Destructive Spondylarthropathy in Hemodialyzed Patients / Arthritis Rheum 27 : 369~375

[journal] Trombetti A / 2013 / Alterations of bone microstructure and strength in end-stage renal failure / Osteoporos Int 24 : 1721~1732

[journal] Stein EM / 2010 / Abnormal Microarchitecture and Reduced Stiffness at the Radius and Tibia in Postmenopausal Women With Fractures / J Bone Miner Res 25 : 2572~2581

[journal] Negri AL / 2012 / Evaluation of bone microarchitecture by high-resolution peripheral quantitative computed tomography(HR-pQCT)in hemodialysis patients / Osteoporos Int 23 : 2543~2550

[journal] Chikawa T / 2013 / Clinical Outcomes of Spinal Surgery in Patients Treated With Hemodialysis / J Spinal Disord Tech 26 : 321~324

[journal] Yoon DH / 2005 / Surgical management of spinal disease in renal recipients / Clin Transplant 19 : 632~637

[journal] Abumi K / 2000 / Surgical treatment of cervical destructive spondyloarthropathy(DSA) / Spine(Phila Pa 1976) 25 : 2899~2905

[journal] Veeravagu A / 2012 / Renal Osteodystrophy:Neurosurgical Considerations and Challenges / World Neurosurg 78(191) : E23~E33

[journal] 이병호 / 2010 / Clinical Outcome of the Operative Treatment for Lumbar Degenerative Spondylopathy in Patients Undergoing Dialysis / 대한척추외과학회지 / 대한척추외과학회 17(2) : 97~103

[journal] Nokura K / 2000 / Dialysis-related spinal canal stenosis: a clinicopathological study on amyloid deposition and its AGE modification / J Neurol Sci 178 : 114~123

[journal] Inatomi K / 2004 / Histological analysis of the ligamentum flavum of patients with dialysisrelated spondyloarthropathy / J Orthop Sci 9 : 285~290

[journal] Ohashi K / 1992 / Cervical discs are most susceptible to beta 2-microglobulin amyloid deposition in the vertebral column / Kidney Int 41 : 1646~1652

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