Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis.
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概要
- 論文の詳細を見る
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.
- American Association of Neurological Surgeonsの論文
著者
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Minami A
Dep. Of Orthopaedic Surgery Graduate School Of Medicine Hokkaido Univ.
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Minami Akio
北海道大学保健管理センター
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Minami Akio
Department Of Orthopaedic Surgery Hokkaido Graduate University School Of Medicine
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Ito Manabu
Orthopaedic Surgery Hokkaido Univ. Graduate School Of Medicine
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Abumi Kuniyoshi
Department Of Orthopaedic Surgery Hokkaido University Graduate School Of Medicine
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Arisue Makoto
Oral And Maxillofacial Surgery School Of Dentistry Health Sciences Univ. Of Hokkaido
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Arisue Makoto
Department Of Orthopaedic Surgery Hokkaido University Graduate School Of Medicine
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Arisue Makoto
Department Of Oral Maxillo-facial Surgery School Of Dentistry Health Sciences University Of Hokkaido
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Kotani Yoshihisa
Dept. Of Orthop. Surg. Hokkaido University
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Arisue Makoto
Dep. Of Orthopaedic Surgery Graduate School Of Medicine Hokkaido Univ.
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