title: Surgical treatment of infectious spondylitis in patients undergoing hemodialysis therapy.
abstract: Treatment of infectious spondylitis in hemodialysis patients remains a challenge because of comorbidities. This study aimed to evaluate the impact of end-stage renal disease (ESRD) on the clinical manifestations and surgical outcomes of patients with spinal infection. Sixteen patients who underwent surgical intervention were included. There were 3 thoracic and 13 lumbar lesions. All patients presented with intractable back pain at the start of treatment. Six patients had a fever, nine had inflammation at the hemodialysis access site, and six of them had concomitant bacteremia. Ten patients had an elevated leukocyte count. Serological tests indicated an elevation of the C-reactive protein and erythrocyte sedimentation rate level in all patients. Five patients had a neurological compromise. Postoperative complications included two mortalities, two iliac bone graft and implant dislodgement, and one retroperitoneal wound dehiscence. The preoperative mean visual analog scale score was 7.7 (range, 6-9), which improved to 3.4 (range, 2-5) at the final follow-up for 14 surviving patients. Neurological improvement was obtained by at least one grade in four Frankel C category patients. The radiographs revealed a good bony fusion in 12 cases although with a variable bone graft subsidence. In conclusion, early diagnosis of infectious spondylitis is difficult due to latent symptoms. A spine infection should be suspected in hemodialysis patients with severe back pain, even when they are afebrile. Surgical intervention for infectious spondylitis in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication and mortality rates are relative high.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, 5 Fu-Hsing St, 333 Kweishan, Taoyuan, Taiwan. lhchen2132@adm.cgmh.org.tw
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Tsai-Sheng
authors.initials: TS
authors.lastname: Fu
authors.forename: Yu-Hsein
authors.initials: YH
authors.lastname: Kao
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Chi-Chieh
authors.initials: CC
authors.lastname: Niu
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013293:Enterococcus faecalis; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy*; D013123:Spinal Fusion; D013166:Spondylitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013203:Staphylococcal Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D013211:Staphylococcus aureus; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome