Abstract
Chronic kidney disease (CKD) and its treatment with hemodialysis (HD) pose unique challenges for spinal surgery due to complications such as destructive spondyloarthropathy (DSA). This study retrospectively compared the surgical outcomes of posterior lumbar interbody fusion (PLIF) between 48 HD patients and 57 non-HD controls. Patients with tumors, infections, prior spinal surgery, or severe osteoporosis were excluded. HD patients had a mean dialysis duration of 16.2 years, while controls were treated for degenerative lumbar conditions. HD patients exhibited significantly higher intraoperative blood loss (415.8 ± 231.7 mL vs 293.4 ± 57.3 mL, P < 0.001) and lower 2-year bony fusion rates (72.9% vs 94.7%, P = 0.008). Pseudoarthrosis and adjacent segment disease (ASD) were more common in the HD group, necessitating reoperation in five cases versus one in controls. Neurological recovery at 2 years was worse in the HD group, with a mean Japanese Orthopaedic Association score of 19.6 ± 4.3 compared to 26.5 ± 2.2 in controls (P < 0.01). Despite facilitating initial neurological recovery, PLIF outcomes in HD patients were compromised by greater complication rates, including pseudoarthrosis and ASD. Thus, PLIF facilitates early neurological improvement in HD patients, but long-term functional outcomes are compromised due to higher rates of pseudoarthrosis and ASD, necessitating careful long-term management. Strategies minimizing mechanical stress and maintaining spinal alignment could further support long-term patient recovery.