Dynamization–Posterior Lumbar Interbody Fusion for Hemodialysis-Related Spondyloarthropathy: Evaluation of the Radiographic Outcomes and Reoperation Rate within 2 Years Postoperatively

Yasukawa Taiki; Ohya Junichi; Kawamura Naohiro; Yoshida Yuichi; Onishi Yuki; Kohata Kazuhiro; Kakuta Yohei; Nagatani Satoshi; Kudo Yoshifumi; Shirahata Toshiyuki; Kunogi Junichi

doi:10.31616/asj.2021.0312

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자료유형: 학술저널

저자정보: Yasukawa Taiki (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Ohya Junichi (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Kawamura Naohiro (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Yoshida Yuichi (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Onishi Yuki (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Kohata Kazuhiro (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Kakuta Yohei (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Nagatani Satoshi (Orthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan) Kudo Yoshifumi (Showa University School of Medicine Tokyo Japan) Shirahata Toshiyuki (Orthopaedic Surgery Showa University School of Medicine Tokyo Japan) Kunogi Junichi (rthopedic Surgery Japanese Red Cross Medical Center Tokyo Japan)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.16 No.5

발행연도: 2022.10

수록면: 684 - 691 (8page)

DOI: 10.31616/asj.2021.0312

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Study Design: Clinical case series.Purpose: This study aimed to report dynamization–posterior lumbar interbody fusion (PLIF), our surgical treatment for hemodialysisrelated spondyloarthropathy (HSA), and investigate patients’ postoperative course within 2 years.Overview of Literature: HSA often requires lumbar fusion surgery. Conventional PLIF for HSA may cause progressive destructive changes in the vertebral endplate, leading to progressive cage subsidence, pedicle screw loosening, and pseudoarthrosis. A dynamic stabilization system might be effective in patients with a poor bone quality. Thus, we performed “dynamization–PLIF” in hemodialysis patients with destructive vertebral endplate changes.Methods: We retrospectively examined patients with HSA who underwent dynamization–PLIF at our hospital between April 2010 and March 2018. The radiographic measurements included lumbar lordosis and local lordosis in the fused segment. The evaluation points were before surgery, immediately after surgery, 1 year after surgery, and 2 years after surgery. The preoperative and postoperative radiographic findings were compared using a paired t-test. A p-value of less than 0.05 was considered significant.Results: We included 50 patients (28 males, 22 females). Lumbar lordosis and local lordosis were significantly improved through dynamization– PLIF (lumbar lordosis, 28.4°–35.5°; local lordosis, 2.7°–12.8°; <i>p</i><0.01). The mean local lordosis was maintained throughout the postoperative course at 1- and 2-year follow-up (12.9°–12.8°, p=0.89 and 12.9°–11.8°, <i>p</i>=0.07, respectively). Solid fusion was achieved in 59 (89%) of 66 fused segments. Solid fusion of all fixed segments was achieved in 42 cases (84%). Within 2 years postoperatively, only six cases (12%) were reoperated (two, surgical debridement for surgical site infection; two, reoperation for pedicle screw loosening; one, laminectomy for epidural hematoma; one, additional fusion for adjacent segment disease).Conclusions: Dynamization–PLIF showed local lordosis improvement, a high solid fusion rate, and a low reoperation rate within 2 years of follow-up.

#Hemodialysis #Destructive spondyloarthropathy #Posterior lumbar interbody fusion #Dynamic stabilization #Dynamization

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