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Low Parathyroid Hormone Levels in Patients Who Underwent/Would Undergo Hemodialysis Result in Bone Graft Failure After Posterolateral Fusion

Kanaya, Koichi MD, PhD; Kato, Yoshiharu MD, PhD; Murata, Yasuaki MD, PhD; Wada, Hiroyoshi MD, PhD; Wada, Keiji MD, PhD; Shimamoto, Shuji MD; Shiba, Masahiro MD; Hatta, Satoshi MD

doi: 10.1097/BRS.0000000000000132
Surgery

Study Design. Case series.

Objective. To reveal the association between levels of parathyroid hormone (PTH) and outcome of bone fusion in patients who underwent/would undergo hemodialysis.

Summary of Background Data. Among the different bone lesions observed in patients who underwent/would undergo hemodialysis, adynamic bone disease is regarded as a factor associated with bone graft failure because of severely reduced bone turnover. Although PTH levels reflect the pathological findings of bone lesions in patients who underwent/would undergo hemodialysis, the relationship between PTH levels and the outcome of bone fusion in patients who underwent/would undergo hemodialysis has not been investigated.

Methods. Patients who underwent/would undergo hemodialysis (n = 48) with lumbar spine lesion underwent posterolateral spinal fusion with instrumentation. The outcome of bone fusion was assessed radiographically 12 months after surgery, and sensitivity and specificity were determined using preoperative PTH levels as the standard.

Results. A significant difference in PTH levels was observed between the good fusion (mean, 235.4 pg/mL) and poor fusion (mean, 100.0 pg/mL) groups. The intersection of the sensitivity and specificity plots, generated using preoperative PTH levels, was 150 pg/mL, and the area under the receiver operating characteristic curve was 0.72.

Conclusion. Low PTH levels are a risk factor for bone graft failure in patients who underwent/would undergo hemodialysis. Accordingly, PTH level can be a useful predictor of the outcome of bone fusion.

Level of Evidence: 4

Low parathyroid hormone (PTH) levels are a risk factor for bone graft failure in hemodialysis patients, and therefore, PTH levels have prognostic value for bone fusion.

From the Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.

Address correspondence and reprint requests to Koichi Kanaya, MD, PhD, Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan; E-mail: makiichi2@aol.com

Acknowledgment date: June 26, 2013. First revision date: September 27, 2013. Second revision date: November 6, 2013. Acceptance date: November 8, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins