Instrumented Posterolateral fusion versus instrumented Interbody fusion for degenerative lumbar diseases in uremic patients under hemodialysis

Advances in hemodialysis have facilitated longer lifespan and better quality of life for patients with end stage renal disease (ESRD). Symptomatic degenerative lumbar diseases (DLD) becomes more common in patients with ESRD. Posterior instrumented fusion remains popular for spinal stenosis combining instability. Only a few sporadic studies mentioned about surgical outcomes in patients with ESRD underwent spine surgeries, but no one discussed about which fusion method was optimal for this kind of patients. In this study, we compared the differences between lumbar posterolateral fusion (PLF) and lumbar interbody fusion (IBF) in uremic patients underwent instrumented lumbar surgeries.

Between January 2005 and December 2017, ESRD patients under maintenance hemodialysis underwent posterior instrumented fusion for DLD were reviewed. A PLF group and an IBF group were identified. The demographic data was collected using their medical records. Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and the visual analogue scale (VAS); radiographic results were assessed using final fusion rates. Any surgical or implant-related complication was documented.

A total of 34 patients (22 women and 12 men, mean age of 65.4 years) in PLF group and 45 patients (26 women and 19 men, mean age of 65.1 years) in IBF group were enrolled. Both groups had similar surgical levels. The operation time was longer (200.9 vs 178.3 min, p = 0.029) and the amount of blood loss was higher (780.0 vs 428.4 ml, p = 0.001) in the IBF group. The radiographic fusion rate was better in the PLF group but without significant difference (65.2% vs 58.8%, p = 0.356). Seven in the PLF group and ten in the IBF group developed surgical complications (20.5% vs. 22.2%, p = 0.788); three patients in the PLF group (8.8%) and five patients in the IBF group (11.1%) received revision surgeries because of implant-related or wound complications. Comparing to preoperative ODI and VAS, postoperative ODI and VAS obtained significant improvement in both groups.

Successful fusion rates and clinical improvement (VAS, ODI) were similar in IBF and PLF group. Uremic patients underwent IBF for DLD had longer length of operation and higher operative blood loss than underwent PLF.