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; Yun-Che Wu; Sheng-Chieh Tseng; Kun-Hui Chen; Chien-Chou Pan; Cheng-Hung Lee

doi:10.3390/jcm10225447

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

J Clin Med. 2021 Nov 22;10(22):5447. doi: 10.3390/jcm10225447.

Authors

Ting-Yu Shih¹, Yun-Che Wu¹, Sheng-Chieh Tseng¹, Kun-Hui Chen¹, Chien-Chou Pan¹, Cheng-Hung Lee^{1

2

3}

Affiliations

¹ Department of Orthopaedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
² Department of Food Science and Technology, Hung Kuang University, Taichung 43302, Taiwan.
³ College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan.

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.

Keywords: adjacent segment disease; anterior cervical discectomy and fusion; cage subsidence; end-stage renal disease; implants loosening; transforaminal lumbar interbody fusion.