투석을 시행하는 퇴행성 요추 질환 환자군에서의 수 술적 치료의 임상결과 = Clinical Outcome of the Operative Treatment for Lumbar Degenerative Spondylopathy in Patients Undergoing Dialysis

다국어 초록 (Multilingual Abstract)

Study Design: This is a retrospective review Objectives: We wanted to evaluate the clinical and radiological outcomes of operative treatment for lumbar degenerative diseases in patients who are undergoing dialysis.
Summary of the Literature Review: Operative treatment for patients having spinal diseases with chronic renal failure (CRF) demands special consideration because of the medical and surgical complications and the poor clinical outcome. There are only few reports on operative treatment for lumbar degenerative diseases for patients who are undergoing dialysis.
Materials and Methods: Eight patients with lumbar degenerative spondylopathy and CRF and who were undergoing dialysis were operated on from August 1998 to September 2007. The clinical and radiological outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scale and the plain X-rays. The serum alkaline phosphatase levels were measured to evaluate the bone metabolism along with the postoperative improvement of clinical symptom.
Results: We had 1 case of postoperative mortality with peritoneal dialysis due to sepsis that was caused by panperitonitis and another complication of discitis. Only 1 of 4 cases that underwent fusion procedure had radiological bony union. The mean JOA scores were 12.0(range: 10-14) preoperatively and 17.3 (range: 5-20) and 15.6 (range: 9-19) at postoperative 6 months and the final follow-up, respectively (p<0.05). The mean serum alkaline phosphatase levels were 80.9 (range: 43-142) preoperatively, 98 (range: 68-164) at postoperative 1month, 75 (range: 50-102) at postoperative 6 months and 108 (range: 60-209) at the final follow-up (p>0.05).
Conclusions: The clinical outcomes of surgical treatments were improved for the degenerative spine disease patients who are undergoing dialysis. However after the fusion procedure, the bony fusion rate was low (25%). Since a high rate of perioperative medical complications can be expected, thorough medical evaluation during preoperation and postoperation is recommended.

국문 초록 (Abstract)

연구 계획: 후향적 연구연구 목적: 투석 시행 중인 만성신부전 환자 중 요추부 퇴행성 질환 환자에 대해 수술적 치료를 시행 후 임상적 및 방사선학적 결과 대해 평가한다.
선행 문헌의 요약: 만성 신부전환자의 척추 질환의 치료에 있어서 수술적 치료는 수술과 관련된 내과적 및 외과적 합병증 및 불량한 임상 경과 등으로인한 특별한 고려가 요구된다. 투석을 시행하는 요추부 퇴행성 질환 치료환자에 대한 수술적 치료의 결과에 대한 보고가 부족하다.
대상 및 방법: 1998년 8월부터 2007년 9월까지 투석 시행하던 요추부 퇴행성 환자 중 수술적 치료를 시행한 8명의 환자에 대해, 임상결과와 방사선학적 결과에 대해 각각 Japanese Orthopaedic Association (JOA) scale과, 추시시 시행한 단순 방사선검사를 이용하여 평가하였다. 혈중 알칼리성 탈인산가수분해효소(serum alkaline phosphatase)를 측정하여, 술 후 임상증상 호전에 따른 활동도 변화에 대한 골 흡수-형성 대사 변화에 대해 간접 평가하였다.
결과: 수술 치료 후 복막투석중인 환자 1예에서 술 후 범발성 복막염에 이은 패혈증으로 사망하였고, 1예의 술 후 디스크 감염이 발생하였다. 방사선학적 평가 결과, 유합술을 시행한 4예 중 1예에서 골유합을 보였다. 평균 JOA scores는 술 전 12.0(10-14)에서 술 후 6개월째 17.3(5-20)으로 호전되었고,최종추시시 15.6(9-19)으로 감소하였다(p<0.05). 혈중 알칼리성 탈인산화효소 레벨은 술 전 80.9(43-142)에서 술 후 1개월과 6개월에 각각 98(68-164),75(50-102)으로 감소하였고, 최종 추시시 108(60-209)로 다시 증가하였다(p>0.05).
결론: 투석환자에서 시행한 요추부 퇴행성 질환에 대한 수술적 치료로 환자의 임상적 증상은 호전되었으며, 골 유합술 시행시 유합률은 떨어지는 것으로 관찰되었다(25%). 수술과 연관된 합병증 발생이 높게 예상되는 만큼 술 전 및 술 후 철저한 의학적 평가가 권장된다.

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