The number of patients undergoing dialysis for end-stage renal disease (ESRD) worldwide continues to increase every year, and the survival rate has been prolonged by recent advances in dialysis [1,2]. Especially in Japan, the high prevalence of dialysis patients and percentage of patients with long dialysis periods were observed due to exclusive dependence on dialysis in renal replacement therapy for ESRD; the percentage of patients with periods of at least 10 years has reached 27.7% in 2018 [2]. However, long-term dialysis negatively affects bone health and is associated with musculoskeletal abnormalities, osteoporosis, destructive spondyloarthropathy (DSA), and spinal stenosis [[3], [4], [5]]. There has been an increase in the number of dialysis patients requiring spine surgery, in accordance with the growth of the dialysis population.

Meanwhile, dialysis patients present with multiple general comorbidities such as cardiovascular disease, diabetes mellitus, anemia, and immune dysfunction, and their life expectancy is significantly shorter than that of the general population [1,2,6]. Dialysis patients undergoing spine surgery have been shown to have an increased risk of major perioperative adverse events, including a tenfold higher risk of in-hospital mortality and increased rates of hospital readmission [7,8]. Furthermore, dialysis dependence has also been associated with negative outcomes after spine surgery, including poor recovery rates, high re-operation rates, adjacent segment disease (ASD), and low fusion rates after fusion surgeries [3,5,9]. Additionally, some long-term follow-up studies have indicated a high mortality rate in dialysis patients after spine surgery [10,11]. Based on these negative data, it is currently considered that spine surgery in dialysis patients should be recommended extremely carefully in view of the risks and benefits. However, the benefits of spine surgery for dialysis patients remain unclear owing to the lack of long-term outcomes. The purpose of this study was to clarify the long-term outcomes of spine surgery in dialysis patients, focusing on activities of daily living (ADLs), life expectancy, and risk factors for postoperative mortality.