Spinal surgery in patients with end-stage renal disease undergoing hemodialysis therapy.
METHODS
Case series retrospective review.


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


BACKGROUND
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.


CONCLUSIONS
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.
Han
In-Ho
IH
Department of Neurosurgery, Pusan University College of Medicine, Pusan National University Hospital, Pusan, South Korea.
Kim
Keun-Su
KS
Park
Hyeong-Cheon
HC
Chin
Dong-Kyu
DK
Jin
Byung-Ho
BH
Yoon
Young-Sul
YS
Ahn
Jung-Yong
JY
Cho
Yong-Eun
YE
Kuh
Sung-Uk
SU
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*