투석을 시행하는 퇴행성 요추 질환 환자군에서의 수술적 치료의 임상결과

Abstract

STUDY DESIGN: This is a retrospective review. OBJECTIVES: We wanted to evaluate the clinical and radiological outcomes of operative treatment for lumbar degenerative diseases in patients who are undergoing dialysis. SUMMARY OF THE LITERATURE REVIEW: Operative treatment for patients having spinal diseases with chronic renal failure (CRF) demands special consideration because of the medical and surgical complications and the poor clinical outcome. There are only few reports on operative treatment for lumbar degenerative diseases for patients who are undergoing dialysis. MATERIALS AND METHODS: Eight patients with lumbar degenerative spondylopathy and CRF and who were undergoing dialysis were operated on from August 1998 to September 2007. The clinical and radiological outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scale and the plain X-rays. The serum alkaline phosphatase levels were measured to evaluate the bone metabolism along with the postoperative improvement of clinical symptom. RESULTS: We had 1 case of postoperative mortality with peritoneal dialysis due to sepsis that was caused by panperitonitis and another complication of discitis. Only 1 of 4 cases that underwent fusion procedure had radiological bony union. The mean JOA scores were 12.0 (range: 10-14) preoperatively and 17.3 (range: 5-20) and 15.6 (range: 9-19) at postoperative 6 months and the final follow-up, respectively (p<0.05). The mean serum alkaline phosphatase levels were 80.9 (range: 43-142) preoperatively, 98 (range: 68-164) at postoperative 1 month, 75 (range: 50-102) at postoperative 6 months and 108 (range: 60-209) at the final follow-up (p>0.05). CONCLUSIONS: The clinical outcomes of surgical treatments were improved for the degenerative spine disease patients who are undergoing dialysis. However after the fusion procedure, the bony fusion rate was low (25%). Since a high rate of perioperative medical complications can be expected, thorough medical evaluation during preoperation and postoperation is recommended