J Korean Soc Spine Surg.  2017 Sep;24(3):154-161. 10.4184/jkss.2017.24.3.154.

Outcomes of Degenerative Lumbar Spine Surgery in Patients with Chronic Kidney Disease Undergoing Hemodialysis

• Jang HD
• Ahn J
• Lee JC
• Choi SW
• Hong S
• Kang D
• Cho HK
• Shin BJ

• KMID: 2402828
• DOI: http://doi.org/10.4184/jkss.2017.24.3.154

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To analyze the outcomes of degenerative lumbar spine surgery in patients undergoing hemodialysis due to chronic kidney disease (CKD). SUMMARY OF LITERATURE REVIEW: Patients who undergo hemodialysis due to chronic renal disease tend to exhibit accelerated changes in bone quality, deterioration of spinal stenosis, and accompanying neurological degeneration. The surgical treatment of chronic spinal diseases is also becoming more necessary with the increased lifespan of these patients.
MATERIALS AND METHODS
We reviewed the medical records and radiographs of patients with CKD undergoing hemodialysis who were followed-up for more than 1 year after posterior lumbar spinal surgery. We evaluated clinical, laboratory, and radiologic variables. For a comparative analysis, patients were classified into subgroups according to age (65 years old), duration of hemodialysis (10 years), and type of surgery (simple decompression or fusion).
RESULTS
We included 21 patients (5 men, 16 women) with a mean age of 66.2 years (range, 48-87 years). The mean duration of hemodialysis and follow-up was 18.9 years and 43 months, respectively. Decompressions with fusion were performed in 11 patients and simple decompressions in the other 10. The mean visual analog scale (VAS) of leg pain and the Oswestry Disability Index (ODI) significantly improved after surgery at time of the last follow-up; meanwhile, the mean VAS score for lower back pain did not show a statistically significant improvement. The postoperative ODI was correlated with age (correlation coefficient=0.71, p=0.006). In patients less than 65 years old, the ODI improvement was greater (p=0.035) than in those 65 years of age or older. There was no significant difference in the clinical outcomes according to the duration of hemodialysis. Complications were observed in 11 patients (52.4%, 7 in fusion and 4 in simple decompression), of which 2 cases were infections, and reoperations were performed in 5 patients. The union rate of the fusion cases at the 1-year follow-up was 81.8%.
CONCLUSIONS
Appropriate spine surgery improved radicular pain and the ODI in patients with degenerative lumbar disease undergoing hemodialysis. However, postoperative complications were frequent and the improvement of clinical outcomes was minimal, especially in patients over 65 years of age and in those who underwent fusion. Therefore, the surgical treatment of patients with chronic renal disease undergoing hemodialysis requires adequate consideration of age and the duration of hemodialysis.

Keyword

Lumbar; Degenerative; End-stage renal disease; Chronic kidney disease; Hemodialysis

MeSH Terms

Decompression
Follow-Up Studies
Humans
Kidney Failure, Chronic
Leg
Low Back Pain
Male
Medical Records
Postoperative Complications
Renal Dialysis*
Renal Insufficiency, Chronic*
Retrospective Studies
Spinal Diseases
Spinal Stenosis
Spine*
Visual Analog Scale

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