Clinical outcomes of spinal surgery in patients treated with hemodialysis.
METHODS
Retrospective study.


OBJECTIVE
The purpose of this study is to review clinical outcomes, including survival rate, and to discuss the potential benefit of surgical treatments for spinal disorders in patients treated with long-term hemodialysis (HD).


BACKGROUND
Long-term HD is known to possibly cause destructive spondyloarthropathy (DSA) with spinal canal stenosis. There have been few reports, however, regarding clinical outcomes and patient survival rates after spinal surgeries in this population.


METHODS
We retrospectively reviewed 33 chronic HD patients who underwent 21 cervical and 13 lumbar spinal surgeries. According to the radiologic findings, we divided them into the non-DSA and the DSA groups. In general, only decompression was performed for the non-DSA patients, whereas spinal fusion was added for the DSA patients. We analyzed the following data, respectively: male-female ratio, age, operative time, estimated blood loss, duration of HD, follow-up duration, preoperative and postoperative Japanese Orthopaedic Association score, improvement ratio of the Japanese Orthopaedic Association score, amyloid deposition characteristics, and survival rate.


RESULTS
All patients improved neurologically and functionally after surgery. There were significant differences in the operative time between the DSA and the non-DSA groups in patients with cervical spinal lesions, whereas in patients with lumbar spinal lesions, there were significant differences in sex, operative time, and estimated blood loss. Amyloid deposition was found signficantly more commonly in DSA than in non-DSA patients and was associated with a longer duration of HD. Nine patients died within 49 months of the surgery because of HD-related complications, but there was no surgery-related morbidity. Kaplan-Meier analysis showed a trend toward decreased survival rate in non-DSA patients more than 40 months after the index surgery.


CONCLUSIONS
Even in patients treated with long-term HD, spinal surgeries reliably obtain neurological and functional improvement if surgeons judge the preoperative inclusion criteria correctly. However, if surgeries are necessary for these patients, surgeons should consider the patients' comorbidity-related survival rate after the spinal surgeries.
Department of Orthopedic Surgery, Tokushima Municipal Hospital, Tokushima, Japan.
Takashi
T
Chikawa
Toshinori
T
Sakai
Nitin N
NN
Bhatia
Ryo
R
Miyagi
Koichi
K
Sairyo
Yuichiro
Y
Goda
Masaru
M
Nakamura
Shunji
S
Nakano
Takeaki
T
Shimakawa
Akira
A
Minato
D000368:Aged; D019299:Decompression, Surgical / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000401:mortality; D013130:Spinal Stenosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D025242:Spondylarthropathies / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome