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Spinal Surgery in Patients With End-Stage Renal Disease Undergoing Hemodialysis Therapy

Han, In-Ho, MD*; Kim, Keun-Su, MD, PhD; Park, Hyeong-Cheon, MD, PhD; Chin, Dong-Kyu, MD, PhD; Jin, Byung-Ho, MD, PhD; Yoon, Young-Sul, MD, PhD; Ahn, Jung-Yong, MD, PhD; Cho, Yong-Eun, MD, PhD; Kuh, Sung-Uk, MD, PhD

doi: 10.1097/BRS.0b013e3181abbdff
Surgery
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Study Design. Case series retrospective review.

Objective. To present the surgical treatment guideline for spinal diseases with end-stage renal disease (ESRD) patients undergoing hemodialysis.

Summary of Background Data. Treatment for spinal diseases with ESRD patients in is a special clinical challenge because of complex medical and clinical problems.

Methods. We retrospectively reviewed 12 patients who underwent spinal surgeries among patients with chronic renal failure at our hospital from May 2000 to September 2007. The medical records and radiologic findings for these patients were reviewed and concomitant medical diseases, laboratory findings, pre- and postoperative care, clinical outcomes, and complications were investigated.

Results. One patient died of pneumonia and sepsis 2 months after fusion surgery. Other postoperative complications included postoperative delirium in 3 patients and terminal ileitis and delayed primary spondylodiscitis in 1 patient each. There were no postoperative wound infections associated with the spinal surgery.

The preoperative mean visual analogue scale score was 7.9 ± 0.61, which improved to 2.2 ± 1.25 at the time of final follow-up for 11 patients. Among 5 patients who underwent fusion surgery, solid bone fusion was achieved in only 3 patients and included those who underwent posterior lumbar interbody fusion with pedicle screw fixation. In 2 patients who underwent posterior lumbar interbody fusion with cage alone, solid fusion was not achieved. In 1 of 2 patients who underwent anterior cervical fusion with plating, solid fusion was achieved. The overall fusion rate was 57.1% in patients with ESRD undergoing hemodialysis.

Conclusion. Spinal surgeries in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication rates and mortality rates are relatively high and the fusion rate is low. To obtain a better outcome, multiple factors such as comorbid medical diseases, laboratory abnormalities, and osteoporosis should be carefully considered.

We retrospectively reviewed 12 patients who underwent spinal surgeries among patients with chronic renal failure. Spinal surgeries in end-stage renal disease patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication rates and mortality rates are relatively high and the fusion rate is low.

From the *Department of Neurosurgery, Pusan University College of Medicine, Pusan National University Hospital, Pusan, South Korea; †Department of Neurosurgery, The Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea; ‡Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Acknowledgment date: September 29, 2008. Revision date: January 17, 2009. Acceptance date: February 25, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by a faculty research grant of Yonsei University College of Medicine for 2008 (No. 6-2008-0290).

The first 2 authors contributed equally to this paper.

Address correspondence and reprint requests to Sung-Uk Kuh, MD, PhD, Department of Neurosurgery, Gangnam Severance Spine Hospital, The Spine and Spinal Cord Institute, 146–92, Dogok-dong, Gangnam-gu, Seoul 135-720, South Korea; E-mail: kuhsu@yuhs.ac

© 2009 Lippincott Williams & Wilkins, Inc.