Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis
Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis
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DOI：
10.3171/spi.2006.5.4.313
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发表时间：
2006-10-01
影响因子：
2.8
通讯作者：
Minami, Akio
中科院分区：
文献类型：
--
作者：
Sudo, Hideki;Ito, Manabu;Minami, Akio
物体。随着越来越多的患者接受长期血液透析，与血液透析相关的颈椎疾病的报告数量也增加了。然而，很少有报道总结这些疾病患者的手术结果。本研究的目的是评价血液透析患者颈椎病手术治疗后的远期随访和临床效果。17名在接受长期血液透析治疗的同时接受颈椎疾病手术的患者纳入本研究。在这些患者中，15人在手术后接受了3年以上的随访，这些人代表了研究人群。其余2例死于术后脓毒症。平均随访期为120个月。5例无脊柱不稳的患者行脊髓减压术，双侧开门椎板成形术。对10例破坏性脊柱关节病(DSA)患者行椎弓根螺钉(PS)内固定术。在8例后路内固定的患者中，采用自体髂骨前路支柱植骨治疗前柱破坏。所有患者在初次手术后均获得明显的神经功能恢复。在先前脊柱融合点附近的活动节段，作者观察到4例(40%)接受环状脊柱融合术的患者出现明显不稳定的渐进性破坏性改变。椎管狭窄患者椎管成形术后无二次手术，DSA无变化。颈椎PS辅助重建提供了良好的融合率和良好的脊柱对齐。然而，在长期的随访期内，由于邻近椎体节段的破坏性改变，一些病例需要延长脊柱融合时间。应制定克服这些问题的指南或建议，以进一步提高血液透析患者的存活率。
Object. As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis.Methods. Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes.Conclusions. Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.