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Posterior Instrumented Lumbar Spinal Surgery in Uremic Patients Under Maintenance Hemodialysis

Yu, Yi-Hsun MD; Chen, Wen-Jer MD; Chen, Lih-Huei MD; Niu, Chi-Chien MD; Fu, Tsai-Sheng MD; Lai, Po-Liang MD

doi: 10.1097/BRS.0b013e3181dc9a33
Clinical Case Series

Study Design. Clinical retrospective cohort study.

Objective. To review the surgical outcome of instrumented lumbar spinal surgery in uremic patients under maintenance hemodialysis and to compare variables between uremic and control patients.

Summary of Background Data. Recent advances in maintenance hemodialysis have enhanced the quality of life and lifespan of uremic patients. The quality of life has markedly increased for uremic patients with instrumented lumbar spinal surgery. Thus far, no single study has evaluated the prognosis of uremic patients with posterior instrumented lumbar spinal surgery.

Methods. Between 2000 and 2006, 34 uremic patients with maintenance hemodialysis underwent posterior instrumented lumbar spinal surgery. Their medical records, laboratory data, the image studies, and the functional outcomes were retrospectively reviewed and compared with the variables of a matched control group.

Results. Uremic patients had significantly lower preoperative hemoglobin and significantly higher perioperative packed red blood cell transfusions. The complication rate was significantly higher in the uremic patients. The solid fusion rates between the two groups were not significantly different. Three-level fusion had a significantly lower solid fusion rate than the single-level and two-level fusions. The visual analog pain scale and the general outcome assessment were not significantly different between the two groups.

Conclusion. As long as standard surgical techniques and perioperative care are performed, the fusion rate and functional outcomes in uremic patients can be comparable to those in the normal population when undergoing posterior instrumented lumbar spinal surgery. We are certain that there will be higher transfusion rate and perioperative complications following such a major surgery in uremic patients. Therefore, the more extensive the instrumented lumbar spinal surgery is for uremic patients, the more closely surgeons should pay attention to preoperative preparation, perioperative management, and postoperative care.

Uremia patients are at a high risk under anesthesia and major surgery. In our institute, the solid fusion rates of the uremic patients and normal patients were similar and not significantly different while performing posterior instrumented lumbar spinal surgery. In addition, satisfactory functional outcomes in uremic patients could be achieved. However, the complication rate in the uremic patients was higher.

From the Department of Orthopedic Surgery and Chang Gung Memorial Hospital and Chang Gung University, Taiwan.

Address correspondence and reprint requests to Wen-Jer Chen, MD, Department of Orthopedic Surgery, Division of Spine Surgery, Chang Gung Memorial Hospital and Chang Gung University, 5, Fu-Hsin St, Kweishan, Taoyuan, Taiwan; E-mail:

Acknowledgment date: July 8, 2009. First Revision date: December 1, 2009. Second Revision date: January 15, 2010. Third Revision date: February 5, 2010. Accepted date: February 8, 2010.

Each author certifies that he has no commercial associations that might pose a conflict of interest in connection with the submitted article.

© 2011 Lippincott Williams & Wilkins, Inc.