Spinal deformity and Parkinson disease: a treatment algorithm

Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease: a retrospective review with analysis of complications

STUDY DESIGN

Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD).

OBJECTIVE

To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction.

SUMMARY OF BACKGROUND DATA

The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PD patients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum.

METHODS

: This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire.

RESULTS

The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition.

CONCLUSIONS

This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.

Bilateral subthalamic deep brain stimulation for camptocormia associated with Parkinson's disease

BACKGROUND

Few multiple case studies of the effects of deep brain stimulation for camptocormia associated with Parkinson's disease have been reported. Although deep brain stimulation was in some cases not effective against camptocormia, it is unclear in which types of patients it was effective in treating camptocormia.

OBJECTIVE

We treated 4 Parkinson's disease patients with camptocormia and evaluated their paraspinal muscle status by computed tomography to specify the characteristics of cases of effective treatment.

METHODS

The 2 female and 2 male patients in this study were 60-69 years old, with a disease duration from onset to surgery of 7-13 years and a follow-up period of 18-40 months. The electrodes were implanted bilaterally in the subthalamic nuclei.

RESULTS

Camptocormia was improved in 3 cases, and was unchanged in the remaining case although other parkinsonian symptoms improved. The computed tomography number of paraspinal muscle in the unimproved patient was much smaller than that in the improved patients.

CONCLUSIONS

A relationship may exist between improvement of camptocormia and severity of paraspinal muscle degeneration.