Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients.

Ting-Yu Shih,Chien-Chou Pan,Sheng-Chieh Tseng,Kun-Hui Chen,Yun-Che Wu,Cheng-Hung Lee

doi:10.3390/jcm10225447

Abstract

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence.

Highlights

In Taiwan, there have been an increasing number of patients with end-stage renal disease (ESRD) requiring dialysis in recent years
The selection criteria for the patients were as follows: (1) all patients were diagnosed with ESRD and had been undergoing dialysis treatment for at least 1 year; (2) all patients had undergone anterior cervical discectomy and fusion (ACDF) surgery or transforaminal lumbar interbody fusion (TLIF) surgery; (3) the patient’s postoperative clinical imaging data and follow-up records were complete, and they were followed up for at least 2 years
Regardless of the ACDF and TLIF groups, no significant correlation between the occurrence of adjacent segment disease (ASD) and preoperative laboratory calcium and phosphate levels, and calcium

Summary

Introduction

In Taiwan, there have been an increasing number of patients with end-stage renal disease (ESRD) requiring dialysis in recent years. Taiwan’s dialysis rate is the highest worldwide [1]. The advancement of dialysis technology has greatly increased the life expectancy of patients with ESRD [2]. Spine surgeons are seeing an increasing number of patients with degenerative spine diseases and ESRD. Spine surgery for patients with ESRD can become a substantial challenge because of its complicated comorbidities, such as susceptibility to infection, osteoporosis, and high in-hospital mortality [3,4]. As shown in the Kidney Disease Improving Global Outcomes guidelines in 2017 [5], patients undergoing dialysis treatment should monitor their serum calcium, phosphate, calcium–phosphate (Ca × P) product, and parathyroid hormone to prevent the occurrence

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