Peculiarities of Spondylitis in the Patients Undergoing Program Hemodialysis (Case Report)

Cover Page


Cite item

Full Text

Abstract

Relevance. The surgical treatment of spinal diseases and injuries in the patients on hemodialysis is one of the most complicated problems of the spine surgery, since such a surgery is associated with an increased risk of infectious complications and perioperative mortality. The case description. A 59-year-old female came to the clinic complaining back pain. Th8-9 vertebrae spondylitis complicated by an epidural and paravertebral abscess with pertinent neurological disorders and bilateral pneumonia were diagnosed. The patient had been on hemodialysis for 18 years due to the end-stage chronic kidney disease complicated by uremic osteodystrophy. The surgical debridement and stabilization of the spine were performed in one stage posterior approach using a titanium mesh implant in combination with autologous bone and posterior instrumentation. A regression of neurological disorders and the pain syndrome relief were achieved. In the late postoperative period, the instability of the posterior fixation developed twice, requiring restabilization. Within the following 3.5 years after the operation, the pain syndrome had not returned. Conclusion. The presence of equipment for hemodialysis and a multidisciplinary approach allow to achieve the positive results in the surgical treatment of inflammatory diseases of the spine in the patients with endstage chronic kidney disease.

About the authors

M. A. Mushkin

Pavlov First St. Petersburg State Medical University

Author for correspondence.
Email: mikhail_mushkin@mail.ru

Mikhail А. Mushkin — Assistant, Department of Traumatology and Orthopedics

St. Petersburg

Russian Federation

A. K. Dulaev

Pavlov First St. Petersburg State Medical University; Dzhanelidze Saint Petersburg Scientific Research Institute of Emergency Medicine, St. Petersburg

Email: fake@neicon.ru

Alexander K. Dulaev — Dr. Sci. (Med.), Professor, Head of Department of Traumatology and Orthopedics, St. Petersburg Dzhanelidze Research Institute of Emergency Medicine; Head of the Department of Traumatology and Orthopedics, Pavlov First St. Petersburg State Medical University

St. Petersburg

Russian Federation

A. N. Tsed

Pavlov First St. Petersburg State Medical University

Email: fake@neicon.ru

Alexander N. Tsed — Cand. Sci. (Med.), Assistant Professor, Department of Traumatology and Orthopedics, Head of Department of Traumatology and Orthopedics No. 2

St. Petersburg

Russian Federation

References

  1. Jassal S.V., Karaboyas A., Comment L.A., Bieber B.A., Morgenstern H., Sen A. et al. Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2016;67(2):283-292. doi: 10.1053/j.ajkd.2015.09.024.
  2. Chikuda H., Yasunaga H., Horiguchi H., Takeshita K., Kawaguchi H., Matsuda S., Nakamura K. Mortality and morbidity in dialysis-dependent patients undergoing spinal surgery: analysis of a national administrative database in Japan. J Bone Joint Surg Am. 2012;94(5): 433-438. doi: 10.2106/JBJS.K.00183.
  3. Abumi K., Ito M., Kaneda K. Surgical treatment of cervical destructive spondyloarthropathy (DSA). Spine (Phila Pa 1976). 2000;25(22):2899-2905. doi: 10.1097/00007632-200011150-00011.
  4. Yamamoto T., Matsuyama Y., Tsuji T., Nakamura H., Yanase M., Ishiguro N. Destructive spondyloarthropathy in hemodialysis patients: comparison between patients with and those without destructive spondyloarthropathy. J Spinal Disord Tech. 2005;18(3):283-285.
  5. Tolkoff-Rubin N.E., Rubin R.H. Uremia and host defenses. N Engl J Med. 1990;322(18):1277-1289. doi: 10.1056/NEJM199003153221109.
  6. Van Driessche S., Goutallier D., Odent T., Piat C., Legendre C., Buisson C. et al. Surgical treatment of destructive cervical spondyloarthropathy with neurologic impairment in hemodialysis patients. Spine (Phila Pa 1976). 2006;31(6):705-711. doi: 10.1097/01.brs.0000203716.99392.bf.
  7. Yu Y.H., Chen W.J., Chen L.H., Niu C.C., Fu T.S., Lai P.L. Posterior instrumented lumbar spinal surgery in uremic patients under maintenance hemodialysis. Spine (Phila Pa 1976). 2011;36(8):660-666. doi: 10.1097/BRS.0b013e3181dc9a33.
  8. Frankel H.L., Hancock D.O., Hyslop G., Melzak J., Michaelis L.S., Ungar G.H. et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I Paraplegia. 1969;7(3):179-192. doi: 10.1038/sc.1969.30.
  9. Баулин И.А., Гаврилов П.В., Советова Н.А., Мушкин А.Ю. Лучевой анализ формирования костного блока при использовании различных материалов для переднего спондилодеза у пациентов с инфекционным спондилитом. Хирургия позвоночника. 2015;12(1):83-89. doi: 10.14531/ss2015.1.83-89.
  10. Гуща А.О., Семенов М.С., Полторако Е.А., Кащеев А.А., Вершинин А.В. Клинические рекомендации по диагностике и лечению воспалительных заболеваний позвоночника и спинного мозга. Москва: Ассоциация нейрохирургов России; 2015. 34 с.
  11. Schimmel J.J.P., Horsting P.P., de Kleuver M. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010;19(10):1711-1719.
  12. Weinstein M.A., McCabe J.P., Cammisa F.P. Postoperative spinal wound infection a review of 2,391 consecutive index procedures. J Spinal Disord. 2000;13(5):422-426. doi: 10.1097/00002517-200010000-00009.
  13. Lu Y.A., Hsu H.H., Kao H.K., Lee C.H., Lee S.Y., Chen G.H. et al. Infective spondylodiscitis in patients on maintenance hemodialysis: a case series. Ren Fail. 2017;39(1): 179-186. doi: 10.1080/0886022X.2016.1256313.
  14. Hori Y., Takahashi S., Terai H., Hoshino M., Toyoda H., Suzuki A. et al. Impact of Hemodialysis on Surgical Outcomes and Mortality Rate after Lumbar Spine Surgery: A Matched Cohort Study. Spine Surg Relat Res. 2018;3(2):151-156. doi: 10.22603/ssrr.2018-0025.
  15. Yamada T., Yoshii T., Hirai T., Inose H., Kato T., Kawabata S., Okawa A. Clinical Outcomes of Spinal Surgery for Patients Undergoing Hemodialysis. Orthopedics. 2016;39(5): e863-868. doi: 10.3928/01477447-20160509-06.
  16. Sasaki M., Abekura M., Morris S., Akiyama C., Kaise K., Yuguchi T. et al. Microscopic bilateral decompression through unilateral laminotomy for lumbar canal stenosis in patients undergoing hemodialysis. J Neurosurg Spine. 2006;5(6):494-499. doi: 10.3171/spi.2006.5.6.494.
  17. Madhavan K., Chieng L.O., Armstrong V.L., Wang M.Y. Spondylodiscitis in end-stage renal disease: a systematic review. J Neurosurg Spine. 2019;30(5):674-682. doi: 10.3171/2018.9.spine18824.
  18. Kehrer M., Pedersen C., Jensen T.G., Lassen A.T. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect. 2014;68(4): 313-320. doi: 10.1016/j.jinf.2013.11.011.
  19. Renz N., Haupenthal J., Schuetz M.A., Trampuz A. Hematogenous vertebral osteomyelitis associated with intravascular device-associated infections – A retrospective cohort study. Diagn Microbiol Infect Dis. 2017;88(1): 75-81. doi: 10.1016/j.diagmicrobio.2017.01.020.
  20. Kuo G., Sun W.C., Lu Y.A., Chen C.Y., Kao H.K., Lin Y.Jr. et al. Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations. Ther Clin Risk Manag. 2018;14:257-263. doi: 10.2147/TCRM.S153546.
  21. Дулаев А.К., Цед А.Н., Муштин Н.Е. Применение транексамовой кислоты при эндопротезировании тазобедренного сустава у пациентов, находящихся на хроническом гемодиализе. Вестник хирургии им. И.И. Грекова. 2018;177(4):47-51. doi: 10.24884/0042-4625-2018-177-4-47-51.
  22. Lasocki S., Krauspe R., von Heymann C., Mezzacasa A., Chainey S., Spahn D.R. PREPARE: the prevalence of perioperative anaemia and need for patient blood management in elective orthopaedic surgery: a multicentre, observational study. Eur J Anaesthesiol. 2015;32(3):160-167. doi: 10.1097/EJA.0000000000000202.
  23. Saeed F., Agrawal N., Greenberg E., Holley J.L. Lower gastrointestinal bleeding in chronic hemodialysis patients. Int J Nephrol. 2011;2011:272535. doi: 10.4061/2011/272535.
  24. Sarnak M.J., Jaber B.L. Mortality caused by sepsis in p tients with end-stage renal disease compared with the general population. Kidney Int. 2000;58(4):1758-1764. doi: 10.1111/j.1523-1755.2000.00337.x.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies