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Spinal Fusion Rate Low in End-Stage Renal Disease Patients

Last Updated: August 24, 2009.

Patients with spinal diseases and end-stage renal disease who are using dialysis may have acceptable outcomes following spinal surgery, but mortality and complication rates appear to be relatively high and fusion rates appear to be low, according to research published in the Aug. 15 issue of Spine.

MONDAY, Aug. 24 (HealthDay News) -- Patients with spinal diseases and end-stage renal disease who are using dialysis may have acceptable outcomes following spinal surgery, but mortality and complication rates appear to be relatively high and fusion rates appear to be low, according to research published in the Aug. 15 issue of Spine.

In-Ho Han, M.D., of the Pusan National University Hospital in South Korea, and colleagues reviewed the outcomes of 12 patients with end-stage renal disease using hemodialysis who underwent spinal surgeries over a seven-year period. Operations included partial hemilaminectomy and discectomy and posterior lumbar interbody fusion (PLIF) with or without pedicle screw fixation.

The researchers note that one patient died of pneumonia and sepsis two months after fusion surgery. Three patients had postoperative delirium, while terminal ileitis and delayed primary spondylodiscitis at another site developed in one patient each. The mean visual analogue scale score improved from 7.9 preoperatively to 2.2 at final follow-up. Out of the five patients undergoing fusion surgery, the investigators found that three treated with PLIF with pedicle screw fixation had solid bone fusion, but two patients who had PLIF with a cage alone did not achieve solid fusion. The overall fusion rate was 57.1 percent.

"To obtain better outcomes, multiple factors such as comorbid medical disease, electrolyte imbalances, blood urea nitrogen and creatinine levels, pulmonary edema, and osteoporosis should be carefully considered," the authors write. "Careful monitoring in the intensive care unit and a team approach with nephrologists is very important during the perioperative period."

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