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Abstract
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.
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Fig. 1 .
The graph shows the serial changes of JOA score and alkaline phosphatase levels with follow-up. No statistical correlation between them was observed with multiple regression analysis(p>0.05).
Table 1.
Summary of cases
Table 2.
Summary of the JOA scoring system, excluding bladder function∗
| Items | Score |
|---|---|
| Subjective symptoms (9 points) | |
| Low-back pain | |
| none | 3 |
| occasionally mild | 2 |
| always present or sometimes severe | 1 |
| always severe | 0 |
| Leg pain &/or numbness | |
| none | 3 |
| occasionally mild | 2 |
| always present or sometimes severe | 1 |
| always severe | 0 |
| Walking ability | |
| normal | 3 |
| able to walk .500 m, w/ pain/numbness/weakness | 2 |
| present | 1 |
| unable to walk 500 m due to pain/numbness/weakness | 0 |
| unable to walk 100 m due to pain/numbness/weakness | 2 |
| Objective signs (6 points) | 1 |
| SLR | 0 |
| normal | |
| 30–70° | 2 |
| <30° | 1 |
| Sensory function | 0 |
| normal | |
| mild disturbance | 2 |
| mild disturbance | 2 |
| apparent disturbance | 1 |
| Motor function | 0 |
| normal (MMT normal) | |
| slightly decreased muscle strength (MMT good) | 2 |
| marked decreased muscle strength (MMT, fair) | 1 |
| Restriction of ADL (14 points)† | 0 |
| none | |
| moderate | |
| severe | |
| Total score | 29 |
Table 3.
Operative treatment and results
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