Spinal surgery following organ transplantation Clinical article

Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Journal of neurosurgery. Spine (Impact Factor: 2.38). 03/2011; 14(6):779-84. DOI: 10.3171/2011.2.SPINE10481
Source: PubMed


Organ transplantation for renal, liver, cardiac, and pulmonary failure has become more common in recent years, and patients are living longer as a result of improved organ preservation methods, immunosuppressive regimens, and general posttransplant care. Some of these patients undergo spine fusion surgery following organ transplantation, and there is little available information concerning outcomes. The authors report on their experience with and the outcomes of spine fusion in this rare and unique immunosuppressed patient group.
Using the Current Procedural Terminology and ICD-9 codes for solid organ transplants, bone marrow transplantations (BMTs), and spine fusion surgeries, the authors searched their patient database between 1997 and 2008. Data points of interest included primary diagnosis, type of organ transplant, immunosuppressant drug therapy, complications from spine surgery, and radiographic analysis of spine fusion. Spine fusion was assessed with CT or radiography at the latest follow-up.
The database search results revealed 5999 patients who underwent heart, lung, liver, kidney, pancreas, intestine, or bone marrow transplant between 1997 and 2008. Eighteen of the 5999 patients underwent a spine fusion surgery while receiving immunosuppressive therapy. Organ transplants included kidney, liver, heart, pancreas, and allogenic BMT. There were 3 deaths unrelated to spine fusion within 1 year of the surgery and 1 death immediately after spine surgery. Graft-versus-host disease developed in 1 patient when prednisone was stopped prior to the spine surgery. Thirteen patients underwent follow-up radiographic imaging at an average of 25 months after spine surgery; 12 demonstrated radiographic fusion.
The results suggest that spine fusion rates are adequate despite immunosuppressive therapy in patients undergoing spinal fusion after transplant procedures. The data also illustrate the high morbidity and mortality rates found in the organ transplant patient population.

1 Follower
9 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients who have undergone myeloablative chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) for conditions such as multiple myeloma, Hodgkin's disease, and primary amyloidosis may be at higher risk for failure of spinal fusion. As HSCT care and outcomes continue to improve, it is increasingly likely that neurosurgeons will encounter patients post-HSCT who require spinal procedures. To our knowledge there are no published data on fusion outcomes in this unique patient population. We report three patients who underwent spinal fusion following an autologous HSCT. Spinal surgery was performed, on average, 4.5years after autologous HSCT. No patients were on immunosuppressant chemotherapy at the time of the procedure, although one patient was being treated with rituximab for disease progression peri-operatively. Average radiographic confirmation of fusion was 37months and all patients ultimately demonstrated fusion, although not without incident. Our results suggest that spinal fusion can occur in patients who have previously undergone myeloablative chemotherapy followed by autologous HSCT.
    Journal of Clinical Neuroscience 10/2012; 20(1). DOI:10.1016/j.jocn.2012.05.009 · 1.38 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Kidney transplantation has become the ideal and successful treatment for medically suitable patients with established kidney disease. This results in increased likelihood of these patients developing unrelated conditions requiring surgery, including spinal surgery. There are only a few publications available regarding spinal patients with renal transplants. A 67-year-old patient presented with recurrent sciatica. Four years prior to this, he received a living donor kidney transplant. He was diagnosed with right L4 radiculopathy due to recurrent foraminal stenosis as a result of the grade I L4/5 spondylolisthesis. He was offered a reoperation including microdecompression and postero-lateral fixation and fusion. The renal transplant necessitated specific pre- and intraoperative considerations. The knee-chest position with extra padding was used to maintain the region of the renal transplant free from any pressure. The renal care was planned in detail by the transplant surgeons and nephrologists and shared with the ward doctors and on-call teams. The procedure was uneventful; there were no signs of intraoperative or postoperative acute renal injury. The patient was discharged 5 days postoperatively; all renal parameters remained within normal ranges and the postoperative plain films demonstrated satisfactory surgical results. The key to success was a multidisciplinary approach and detailed planning regarding pre-, intra- and postoperative care. The presented scheme of care might be useful when considering the posterior approach and prone positioning in kidney transplant recipients with spinal pathologies requiring surgical treatment.
    European Spine Journal 07/2015; DOI:10.1007/s00586-015-4085-9 · 2.07 Impact Factor