Department of Neurosurgery, Pusan University College of Medicine, Pusan National University Hospital, Pusan, South Korea.
Spine (Phila Pa 1976). 2009 Aug 15;34(18):1990-4. doi: 10.1097/BRS.0b013e3181abbdff.
Case series retrospective review.
To present the surgical treatment guideline for spinal diseases with end-stage renal disease (ESRD) patients undergoing hemodialysis.
Treatment for spinal diseases with ESRD patients in is a special clinical challenge because of complex medical and clinical problems.
We retrospectively reviewed 12 patients who underwent spinal surgeries among patients with chronic renal failure at our hospital from May 2000 to September 2007. The medical records and radiologic findings for these patients were reviewed and concomitant medical diseases, laboratory findings, pre- and postoperative care, clinical outcomes, and complications were investigated.
One patient died of pneumonia and sepsis 2 months after fusion surgery. Other postoperative complications included postoperative delirium in 3 patients and terminal ileitis and delayed primary spondylodiscitis in 1 patient each. There were no postoperative wound infections associated with the spinal surgery.The preoperative mean visual analogue scale score was 7.9 +/- 0.61, which improved to 2.2 +/- 1.25 at the time of final follow-up for 11 patients. Among 5 patients who underwent fusion surgery, solid bone fusion was achieved in only 3 patients and included those who underwent posterior lumbar interbody fusion with pedicle screw fixation. In 2 patients who underwent posterior lumbar interbody fusion with cage alone, solid fusion was not achieved. In 1 of 2 patients who underwent anterior cervical fusion with plating, solid fusion was achieved. The overall fusion rate was 57.1% in patients with ESRD undergoing hemodialysis.
Spinal surgeries in ESRD patients undergoing hemodialysis can be performed with acceptable outcomes; however, the complication rates and mortality rates are relatively high and the fusion rate is low. To obtain a better outcome, multiple factors such as comorbid medical diseases, laboratory abnormalities, and osteoporosis should be carefully considered.
病例系列回顾性研究。
介绍终末期肾病（ESRD）患者接受血液透析时脊柱疾病的手术治疗指南。
由于复杂的医疗和临床问题，ESRD 患者脊柱疾病的治疗是一项特殊的临床挑战。
我们回顾性分析了 2000 年 5 月至 2007 年 9 月期间在我院接受脊柱手术的 12 例慢性肾衰竭患者的病历和影像学检查结果。回顾了这些患者的合并症、实验室检查、围手术期护理、临床结果和并发症。
1 例融合术后 2 个月死于肺炎和脓毒症。其他术后并发症包括 3 例术后谵妄和 1 例末端回肠炎和延迟性原发性脊椎炎。脊柱手术后无伤口感染。11 例患者的术前平均视觉模拟量表评分（VAS）为 7.9 +/- 0.61，最终随访时改善至 2.2 +/- 1.25。在 5 例行融合术的患者中，仅 3 例患者获得了坚固的骨融合，包括接受后路腰椎间融合和椎弓根螺钉固定的患者。2 例单独接受后路腰椎间融合和 cage 的患者未获得坚固融合。在接受前路颈椎融合和钢板固定的 2 例患者中，1 例获得了坚固融合。接受血液透析的 ESRD 患者的总体融合率为 57.1%。
ESRD 患者接受血液透析时可以进行脊柱手术，结果可以接受；然而，并发症发生率和死亡率相对较高，融合率较低。为了获得更好的结果，应仔细考虑合并症、实验室异常和骨质疏松等多种因素。
