Clinical Outcomes of Spinal Surgery for Patients Undergoing Hemodialysis

摘要

This study investigated the surgical outcomes of spinal surgery for degenerative disorder in patients undergoing hemodialysis. Forty patients maintained on hemodialysis who underwent spinal surgery were reviewed. Of the 17 cases of cervical surgery, anterior fusion was performed in 3 patients, laminoplasty in 12, and posterior fusion in 2. Of the 29 cases of lumber surgery, decompression surgery was performed in 14 patients, spinal fusion in 14, and balloon kyphoplasty in 1. The authors focused on cases of destructive spondyloarthropathy (DSA) and retrospectively compared the non-DSA and DSA groups by examining multiple clinical parameters. Intra- or postoperative severe complications occurred in 4 (10%) patients, and 1 (2.5%) patient died due to cardiac failure. The reoperation rate was 27.6% in patients undergoing lumbar surgery and 5.9% in patients undergoing cervical surgery. Five (35.7%) of 14 patients treated with decompression alone subsequently underwent fusion surgery as a revision intervention. Furthermore, 3 (21.4%) of 14 patients undergoing lumbar surgery treated with a primary spinal fusion subsequently underwent an extended fusion surgery. Although there was no significant difference in the recovery rate of the Japanese Orthopaedic Association scores between the non-DSA and DSA groups, severe complications after spinal surgery tended to occur in the DSA group. Although good neurological recovery can be expected in patients undergoing hemodialysis, attention should be paid to the potential for postoperative complications. Severe complications tended to occur in patients with DSA or in those undergoing hemodialysis for more than 15 years.