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Bourghli A, Boissière L, Obeid I. The Obeid-coronal malalignment classification is reliable and helps guiding decision-making and surgical management of adult spinal deformities: letter to the editor of BMC Musculoskeletal Disorders. BMC Musculoskelet Disord 2023; 24:145. [PMID: 36823582 PMCID: PMC9948463 DOI: 10.1186/s12891-023-06257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
A recently published article by Zhang et al. in BMC Musculoskeletal Disorders reported that the classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. The aim of the paper was to specifically discredit the Obeid-Coronal Malalignment (O-CM) classification. In this correspondence, we thought it judicious to clarify misunderstood concepts by the authors. We highlight several limitations of their study, and explain the deep interest of the classification from our perspective in order to avoid misleading the readers. Overarching, we aim to help the colleagues through a constructive rather than destructive approach to better understand the foundations of a coronal malalignment classification.
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Affiliation(s)
- Anouar Bourghli
- Spine surgery department, King Faisal Special Hospital and Research Center, P.O.Box 3354, 11211, Riyadh, Saudi Arabia.
| | - Louis Boissière
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
| | - Ibrahim Obeid
- Clinique du Dos, Elsan Jean Villar Private hospital, Bordeaux, France
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Cao S, Cui Y, Jin J, Li F, Liu X, Feng T. Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis. J Neurol 2023; 270:139-151. [PMID: 36098837 DOI: 10.1007/s00415-022-11354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. METHODS PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. RESULTS There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. CONCLUSIONS Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.
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Affiliation(s)
- Shuangshuang Cao
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Yidu Central Hospital of Weifang, Shandong, China
| | - Yusha Cui
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianing Jin
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fangfei Li
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xin Liu
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Tao Feng
- Department of Neurology, Center for Movement Disorders, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Spindler P, Alzoobi Y, Truckenmüller P, Hahn S, Manzoni YN, Feldmann L, Hermann KG, Kühn AA, Faust K, Schneider GH, Vajkoczy P, Schmidt H. A noninvasive method to quantify the impairment of spinal motion ability in Parkinson's disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3316-3323. [PMID: 36194297 DOI: 10.1007/s00586-022-07401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/01/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE There is a high demand on spinal surgery in patients with Parkinson's disease (PD) but the results are sobering. Although detailed clinical and radiological diagnostics were carried out with great effort and expense, the biodynamic properties of the spine of PD patients have never been considered. We propose a noninvasive method to quantify the impairment of motion abilities in patients with PD. METHODS We present an analytical cross-sectional study of 21 patients with severe PD. All patients underwent a biodynamic assessment during a standardized movement-choreography. Thus, individual spinal motion profiles of each patient were objectively assessed and compared with a large comparative cohort of individuals without PD. Moreover, clinical scores to quantify motor function and lumbar back pain were collected and X-ray scans of the spine in standing position were taken and analysed. RESULTS Biodynamic measurement showed that 36.9% of the assessed motions of all PD patients were severely impaired. Men were generally more functionally impaired than women, in 52% of all motion parameters. The neurological and radiological diagnostics recorded pathological values, of which UPDRS-III ON correlated with findings of the biodynamics assessment (R = 0.52, p = 0.02). CONCLUSIONS The decision to operate on a PD patient's spine is far-reaching and requires careful consideration. Neurological and radiological scores did not correlate with the biodynamics of the spine. The resulting motion profile could be used as individual predictive factor to estimate whether patients are eligible for spinal surgery or alternative therapies.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Truckenmüller
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Sabine Hahn
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yves N Manzoni
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Lucia Feldmann
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kay-Geert Hermann
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Hendrik Schmidt
- Julius Wolff Institute, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Zhang J, Yu Y, Gao S, Hai Y, Wu B, Su X, Wang Z. The classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. BMC Musculoskelet Disord 2022; 23:300. [PMID: 35351065 PMCID: PMC8962466 DOI: 10.1186/s12891-022-05246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/09/2022] [Indexed: 12/03/2022] Open
Abstract
Study design Retrospective case–control radiographic study. Objective To identify main effects of preoperative pattern and global coronal malalignment (GCM) on postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients and evaluate the rationality of the classification of coronal deformity based on preoperative GCM. Summary of background data A classification of coronal deformity based on preoperative GCM (20 mm set as the threshold of coronal imbalance) has been proposed recently, but whether it is practical is unclear. Methods One hundred twelve DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included GCM and major Cobb angle. Based on relationship between C7 PL and major curve, preoperative patterns were classified into: Pattern 1(concave pattern), C7 PL shifted to the concave side of major curve; Pattern 2(convex pattern), C7 PL shifted to the convex side of major curve. Patients were separated into 4 groups (3 types): Type 0–1: GCM < 20 mm plus Pattern 1; Type 0–2: GCM < 20 mm plus Pattern 2; Type 1: GCM > 20 mm plus Pattern 1; Type 2: GCM > 20 mm plus Pattern 2. After comparison within patterns or among 4 groups, further factorial analysis was performed. Results Significant differences regarding postoperative GCM or coronal imbalance/balance ratio existed among 4 groups (F = 6.219, p = 0.001; x2 = 22.506, p < 0.001, respectively), despite no significant difference in intra-pattern 1(concave pattern) or intra-pattern 2(convex pattern) groups. Two-way analysis of variance showed preoperative pattern exhibited significant effect on postoperative GCM or imbalance/balance ratio (F(1,108) = 14.286, p < 0.001; F(1,108) = 30.514, p < 0.001, respectively) while neither preoperative GCM alone nor interaction of preoperative GCM with pattern did. Conclusion In DLS patients, it’s the preoperative pattern other than GCM that had main effects on postoperative coronal imbalance. Classification of coronal deformity based on preoperative GCM is questionable. Level of evidence 3
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Plais N, Bao H, Lafage R, Kim HJ, Gupta M, Smith JS, Shaffrey C, Mundis G, Burton D, Ames C, Klineberg E, Bess S, Hostin RA, Schwab F, Lafage V. Fractional Curve in Adult Spinal Deformity: Is it a Driver of or a Compensation for Coronal Malalignment? Clin Spine Surg 2021; 34:E276-E281. [PMID: 38011511 DOI: 10.1097/bsd.0000000000001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 12/22/2020] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN This was a retrospective review of the multicenter adult spine deformity database. OBJECTIVE The objective of this study was to investigate the role of the fractional curve (FC) on global coronal malalignment. SUMMARY OF BACKGROUND DATA Despite being very common, the role of the coronal FC as either a driver or compensation for global coronal malalignment is not well documented. MATERIALS AND METHODS Patients with the following characteristics were extracted from a prospective multicenter database: lumbar/thoracolumbar (TL) major coronal curve >15 degrees, apex at T11-L3, lower end vertebra at L3 or L4, above 45 years old, and FC >5 degrees. In addition to the classic radiographic parameters, baseline analysis included Cobb angle, pelvic obliquity (PO), fractional ratio (fractional Cobb/main Cobb), the sum of PO and FC, as well as the coronal Qiu classification. Curves distribution (TL vs. FC) were compared across the 3 Qui types, and the role of the FC was investigated. RESULTS A total of 404 patients (63 y old, 83.3% female) were included: 43 patients were classified as type B, 120 as type C, and 241 were coronally balanced (type A). Compared with the balanced patients, type C patients had similar major TL Cobb angles but significantly larger fractional Cobb angles (17.5 vs. 22.3 degrees, P<0.001). By opposition, type B patients had significantly larger major TL Cobb angles (49 vs. 41 degrees, P=0.001) but smaller fractional Cobb angles (P<0.001). PO>5 degrees in the same direction as FC was more common in type B patients (20%) than in type C patients (7.5%), which suggests the preferential role of pelvic compensation. CONCLUSIONS Our findings challenge the idea that FC is only a compensatory curve below a main lumbar or TL curve. In type B patients, FC acts as a compensation mechanism but fails to maintain coronal alignment despite the presence of PO. In type C patients, however, the lumbosacral FC acts as a primary driver of coronal malalignment. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nicolas Plais
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- San Cecilio University Hospital in Granada, Granada, Spain
| | - Hongda Bao
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
- Nanjing Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA
| | | | - Gregory Mundis
- San Diego Spine Foundation, San Diego
- Scripps Clinic, La Jolla, CA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA
| | - Shay Bess
- Presbyterian/St. Luke's Medical Center & Rocky Mountain Hospital for Children, Denver, CO
| | | | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Spinal Surgery for Parkinson Disease With Camptocormia: Propensity Score-Matched Cohort Study With Degenerative Sagittal Imbalance (DSI). Clin Spine Surg 2020; 33:E563-E571. [PMID: 32341323 DOI: 10.1097/bsd.0000000000000994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A propensity score-matched cohort study. OBJECTIVE The objective of this study was to compare the radiologic and clinical outcomes of camptocormia in Parkinson disease (PD) with degenerative sagittal imbalance (DSI) patients. SUMMARY OF BACKGROUND DATA Camptocormia in PD and DSI could be characterized by a dynamic deformity. However, no study has directly evaluated the outcomes of patients with camptocormia and DSI. METHODS Thirteen consecutive PD patients undergoing surgical correction for camptocormia were matched in a 1-to-2 format with 26 patients in the DSI group by propensity score-matching. Radiologic outcomes, including paravertebral muscle changes, and clinical outcomes were compared between the 2 groups. The rate of proximal junctional problems and reoperations were assessed. RESULTS PD patients with camptocormia had significantly greater preoperative coronal and sagittal malalignments (29.9 vs. 16.9 mm, P=0.019; 142.8 vs. 64.4 mm, P=0.0001, respectively) and weakness of paravertebral muscles compared with the DSI patients. Regarding the clinical outcomes, reoperations were significantly higher in the camptocormia group, compared with the DSI group (53.8% vs. 7.7%, P=0.001). Moreover, proximal junctional failure was developed in 8 patients in the camptocormia group, while 1 patient in the DSI group (61.5% vs. 3.8%, P=0.0001). In subgroup analysis, independent risk factors for the proximal junctional failure were the total fusion levels (hazard ratio=0.26, P=0.018) and the degree of fatty changes of the paravertebral muscles (hazard ratio=1.15, P=0.048). CONCLUSIONS PD patients undergoing spinal surgery for camptocormia had global malalignment and higher rates of complications compared with DSI patients. Patients should be appropriately counseled regarding the increased risk of operative complications and closely followed for incipient failure.
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Tang H, Chen Y, Cen Z, Ouyang Z, Lou D, Tan Y, Luo W. The link between lateral trunk flexion in Parkinson's disease and vestibular dysfunction: a clinical study. Int J Neurosci 2020; 131:521-526. [PMID: 32942935 DOI: 10.1080/00207454.2020.1825419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lateral trunk flexion (LTF) is a common postural deformity in Parkinson's disease (PD). Postural control is known to depend on visual, vestibular, and somatosensory information. OBJECTIVES This study aimed to investigate the relationship between vestibular dysfunction and postural abnormalities in PD patients with LTF. METHODS We enrolled a total of 19 PD patients with LTF (PD-LTF+) and 19 age- and sex-matched PD patients without LTF (PD-LTF-). All patients underwent vestibular tests, including spontaneous nystagmus, gaze-evoked nystagmus, ocular movements, optokinetic eye test, fast positioning maneuvers, and the bithermal caloric test. RESULTS Most of the PD-LTF + patients had abnormal vestibular function (11/19), while there were fewer vestibular function injuries in the control group (3/19). In PD-LTF + group, there were 5 patients (5/11, 45.5%) of peripheral vestibular dysfunction, 2 patients (2/11, 18.2%) of central vestibular damage, and 4 patients (4/11, 36.4%) of mixed injuries. The peripheral vestibular deficiencies could be either bilateral (4/9, 44.4%) or unilateral (5/9, 55.6%). The unilateral vestibular dysfunction was ipsilateral to the leaning side in 2 patients and contralateral to the leaning side in the other 3 patients. CONCLUSION Vestibular dysfunction may be an independent risk factor for LTF in PD patients.
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Affiliation(s)
- Haiyan Tang
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China.,Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - You Chen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhidong Cen
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhiyuan Ouyang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Danning Lou
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ying Tan
- Department of Neurology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
| | - Wei Luo
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Matsumura A, Namikawa T, Kato M, Hori Y, Hidaka N, Nakamura H. Factors related to postoperative coronal imbalance in adult lumbar scoliosis. J Neurosurg Spine 2020; 34:66-72. [PMID: 32886910 DOI: 10.3171/2020.6.spine20670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to analyze the prevalence of postoperative coronal imbalance (CIB) and related factors in patients with adult lumbar scoliosis. METHODS This was a retrospective single-center study of data from patients with adult spinal deformity (ASD) who had undergone corrective surgery performed by a single surgeon between 2009 and 2017. The inclusion criteria were as follows: 1) age at surgery > 40 years, 2) Cobb angles of the thoracolumbar/lumbar (TL/L) curve > 40°, 3) upper instrumented vertebra of T9 or T10, 4) lowest instrumented vertebra of L5 or the pelvis, and 5) minimum 2-year follow-up period. Radiographic parameters were measured before surgery, 2 weeks after surgery, and at the latest follow-up. Curve flexibility was also assessed using side bending radiographs. Clinical outcomes were evaluated using the 22-Item Scoliosis Research Society Outcomes Questionnaire (SRS-22) and the SF-36. CIB was considered to have occurred if the C7 plumbline was more than 2.5 cm lateral to the central sacral vertical line (i.e., coronal vertical axis [CVA] > 2.5 cm) at the final follow-up. Parameters between the patients with (CIB group) and without (coronal balance [CB] group) CIB were compared, and factors related to CIB were evaluated. RESULTS From among 66 consecutively treated ASD patients, a total of 37 patients (mean age at surgery 66.3 years, average follow-up 63 months) met the study inclusion criteria. CIB was found in 6 patients at the final follow-up (16.2%), and the CVA of all patients in the CIB group shifted to the convex side of the TL/L curve. A comparative analysis between the CB and CIB groups, respectively, at the final follow-up indicated the following factors were related to CIB: lumbosacral (LS) curve, 11.0°/16.5° (p = 0.02); LS correction rate (CR), 61%/47% (p = 0.02); and CR ratio (LS vs TL/L), 0.93/0.67 (p = 0.0002). Regarding clinical outcomes, the satisfaction domain of the SRS-22 (CB 4.4 vs CIB 3.5) showed a significant difference between the CIB and CB groups (p = 0.02), and patients in the CB group tended to score better on the pain domain (CB 4.3 vs CIB 3.7), but the difference was not significant (p = 0.06). CONCLUSIONS Postoperative CIB negatively impacted patients' HRQOL. An imbalanced correction ratio between the TL/L and LS curves may cause postoperative CIB. Therefore, adequate correction of the LS curve may prevent postoperative CIB.
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Affiliation(s)
- Akira Matsumura
- 1Department of Orthopaedic Surgery, Osaka City General Hospital; and
| | - Takashi Namikawa
- 1Department of Orthopaedic Surgery, Osaka City General Hospital; and
| | - Minori Kato
- 1Department of Orthopaedic Surgery, Osaka City General Hospital; and
| | - Yusuke Hori
- 1Department of Orthopaedic Surgery, Osaka City General Hospital; and
| | - Noriaki Hidaka
- 1Department of Orthopaedic Surgery, Osaka City General Hospital; and
| | - Hiroaki Nakamura
- 2Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2287-2294. [PMID: 32588234 DOI: 10.1007/s00586-020-06513-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. METHODS Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. RESULTS Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. CONCLUSIONS Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.
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Adult Spinal Deformity Surgery in Patients With Movement Disorders: A Propensity-matched Analysis of Outcomes and Cost. Spine (Phila Pa 1976) 2020; 45:E288-E295. [PMID: 32045403 DOI: 10.1097/brs.0000000000003251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a retrospective study using national administrative data from the MarketScan database. OBJECTIVE To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery. SUMMARY OF BACKGROUND DATA Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown. METHODS The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls. RESULTS A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay. CONCLUSION Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders. LEVEL OF EVIDENCE 3.
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Plais N, Bao H, Lafage R, Gupta M, Smith JS, Shaffrey C, Mundis G, Burton D, Ames C, Klineberg E, Bess S, Schwab F, Lafage V. The clinical impact of global coronal malalignment is underestimated in adult patients with thoracolumbar scoliosis. Spine Deform 2020; 8:105-113. [PMID: 31981146 DOI: 10.1007/s43390-020-00046-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 05/11/2019] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective review of multicenter adult spine deformity (ASD) database. OBJECTIVES A recent publication demonstrated that the laterality of the coronal offset is a key parameter that directly impacts postoperative outcomes. The objective of this study is to analyze the relationship between global coronal malalignment (GCM) and functional outcomes in a North American population of ASD patients with no history of previous surgery. The clinical impact of GCM in patients with ASD remains controversial. METHODS Primary patients were drawn from a multicenter database of ASD patients and categorized with the Qiu classification: Type A = GCM < 3 cm; Type B = GCM > 3 cm toward the concave side of the curve; and Type C = GCM > 3 cm toward the convex side. In addition to the classic radiographic parameter, the coronal truncal inclination was investigated in regard to the pelvic obliquity. Clinical outcomes, radiographic parameters, and demographics were compared across the three Qiu Types using analysis of variance. The analysis was repeated after propensity matching of the three types by age and sagittal alignment (PI-LL mismatch, pelvic tilt, and sagittal vertical axis). RESULTS 576 ASD patients (mean age 58.8 years) were included. Type B patients had significantly worse functional scores (Oswestry Disability Index, 36-item Short Form Survey physical component summary, and Scoliosis Research Society-22) and a more severe coronal deformity in terms of maximum Cobb angle, global coronal deformity angle, and coronal malalignment; they were also older (65.4 vs. 58.8 years, p = 0.004) and displayed more severe sagittal malalignment. Similar findings were observed after propensity matching. CONCLUSIONS This study is the first to establish an association between functional outcomes and the severity of the coronal plane deformity in the setting of a specific coronal curve pattern in patients without previous surgery. Coronal malalignment significantly affects the health status of patients when the offset is greater than 3 cm in the direction of curve concavity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Nicolas Plais
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
- Hospital Universitario San Cecilio, Granada, Spain.
| | - Hongda Bao
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Nanjing Drum Tower Hospital, Nanjing University, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, 210008, Jiangsu Sheng, China
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia, P.O. Box 800212, Charlottesville, VA, USA
| | - Gregory Mundis
- San Diego Spine Foundation, 6190 Cornerstone Ct. Suite 212, San Diego, CA, 92121, USA
- Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA, 92036, USA
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Shay Bess
- Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO, 80205, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Prakash N, Caspell-Garcia C, Coffey C, Siderowf A, Tanner CM, Kieburtz K, Mollenhauer B, Galasko D, Merchant K, Foroud T, Chahine LM, Weintraub D, Casaceli C, Dorsey R, Wilson R, Herzog M, Daegele N, Arnedo V, Frasier M, Sherer T, Marek K, Frank S, Jennings D, Simuni T. Feasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI). Parkinsonism Relat Disord 2019; 62:201-209. [PMID: 30738748 DOI: 10.1016/j.parkreldis.2018.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC). BACKGROUND Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants. DESIGN/METHODS Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. All PPMI participants undergo LP at baseline, 6, 12 months and yearly thereafter. CSF collection is performed by a trained investigator using predominantly atraumatic needles. Adverse events (AEs) are monitored by phone one week after LP completion. We analyzed safety data from baseline LPs. RESULTS PPMI enrolled 683 participants (423 PD/196 HC/64 SWEDDs) from 23 study sites. CSF was collected at baseline in 97.5% of participants, of whom 5.4% underwent collection under fluoroscopy. 23% participants reported any related AEs, 68% of all AE were mild while 5.6% were severe. The most common AEs were headaches (13%) and low back pain (6.5%) and both occurred more commonly in HC and SWEDDs compared to PD participants. Factors associated with higher incidence of AEs across the cohorts included female gender, younger age and use of traumatic needles with larger diameter. AEs largely did not impact compliance with the future LPs. CONCLUSIONS LPs are safe and feasible in PD research participants. Specific LP techniques (needle type and gauge) may reduce the overall incidence of AEs.
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Affiliation(s)
- Neha Prakash
- Northwestern University Feinberg School of Medicine, USA.
| | | | | | | | | | | | - Brit Mollenhauer
- Center of Parkinsonism and Movement Disorders Paracelsus-Elena Klinik Kassel and University Medical Center Goettingen, Germany.
| | | | | | | | | | | | | | - Ray Dorsey
- University of Rochester Medical Center, USA.
| | - Renee Wilson
- Clinical Trial Coordination Center, University of Rochester Medical Center, USA.
| | | | | | | | | | | | - Ken Marek
- Institute for Neurodegenerative Disorders, USA.
| | - Samuel Frank
- Harvard Medical School, Beth Israel Deaconess Medical Center, Parkinson's Disease and Movement Disorders Center, Director of the HDSA Center of Excellence, USA.
| | | | - Tanya Simuni
- Northwestern University Feinberg School of Medicine, USA.
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Coronal Imbalance After Three-Column Osteotomy in Thoracolumbar Congenital Kyphoscoliosis: Incidence and Risk Factors. Spine (Phila Pa 1976) 2019; 44:E99-E106. [PMID: 29975329 DOI: 10.1097/brs.0000000000002773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective radiographical clinical study. OBJECTIVE To investigate the incidence and risk factors of coronal imbalance (CI) after three-column osteotomy (3-CO) in patients with thoracolumbar congenital kyphoscoliosis (CKS). SUMMARY OF BACKGROUND DATA The incidence and risk factors of postoperative CI have been reported in adolescent idiopathic and degenerative lumbar scoliosis. However, limited data exists for patients with CKS after 3-CO. METHODS We reviewed a consecutive series of patients with CKS who underwent posterior-only 3-CO. Coronal curve patterns were classified according to absolute C7 translation values into: Type A, C7 translation is less than 30 mm; Type B, C7 translation more than or equal to 30 mm and C7 plumb line (C7PL) shifted to the concave side of the main curve; and Type C, C7 translation more than or equal to 30 mm and C7PL shifted to the convex side. CI was defined as C7 translation on either side more than or equal to 30 mm. According to C7 translation at the latest follow-up, patients was subdivided into an imbalanced group and a balanced group. RESULTS One-hundred-thirty patients (mean age, 17.7 ± 5.2 yr) were recruited. The mean follow-up was 41.3 ± 18.5 months. Twenty-six patients (20%) were identified as having CI at the latest follow-up. Compared with the balanced group, the imbalanced group had a larger proportion of preoperative Type C pattern, higher main curve correction, and greater lowest instrumented vertebra (LIV) tilt before and after surgery. Multiple logistic regression showed that risk factors for CI were preoperative type C pattern, preoperative LIV tilt more than or equal to 23.5° and immediate postoperative LIV tilt more than or equal to 12.3°. CONCLUSION The incidence of CI in patients with CKS after 3-CO was 20%. A preoperative type C pattern, preoperative LIV tilt more than or equal to 23.5°, and immediate postoperative LIV tilt more than or equal to 12.3° were found to be associated with CI at the latest follow-up. LEVEL OF EVIDENCE 3.
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Galazky I, Caspari C, Heinze HJ, Franke J. The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2847-2853. [DOI: 10.1007/s00586-018-5748-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/06/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
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15
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Galbusera F, Bassani T, Stucovitz E, Martini C, Ismael Aguirre MF, Berjano PL, Lamartina C. Surgical treatment of spinal disorders in Parkinson's disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:101-108. [PMID: 29397444 DOI: 10.1007/s00586-018-5499-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Most patients suffering from Parkinson's disease (PD) exhibit alterations in the posture, which can in several cases give rise to spine deformities, both in the sagittal and the coronal plane. In addition, degenerative disorders of the spine frequently associated to PD, such as spinal stenosis and sagittal instability, can further impact the quality of life of the patient. In recent years, spine surgery has been increasingly performed, with mixed results. The aim of this narrative review is to analyze the spinal disorders associated to PD, and the current evidence about their surgical treatment. METHODS Narrative review. RESULTS Camptocormia, i.e., a pronounced flexible forward bending of the trunk with 7% prevalence, is the most reported sagittal disorder of the spine. Pisa syndrome and scoliosis are both common and frequently associated. Disorders to the spinopelvic alignment were not widely investigated, but a tendency toward a lower ability of PD patients to compensate the sagittal malalignment with respect to non-PD elderly subjects with imbalance seems to emerge. Spine surgery in PD patients showed high rates of complications and re-operations. CONCLUSIONS Disorders of the posture and spinal alignment, both in the sagittal and in the coronal planes, are common in PD patients, and have a major impact on the quality of life. Outcomes of spine surgery are generally not satisfactory, likely mostly due to muscle dystonia and poor bone quality. Knowledge in this field needs to be consolidated by further clinical and basic science studies. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Fabio Galbusera
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Elena Stucovitz
- Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlotta Martini
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy.
| | | | - Pedro L Berjano
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
| | - C Lamartina
- G Spine 4, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
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16
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Redaelli A, Berjano P, Aebi M. Focal disorders of the spine with compensatory deformities: how to define them. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:59-69. [PMID: 29383486 DOI: 10.1007/s00586-018-5501-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE In this paper, the authors propose classifying the epiphenomenon of spinal deformity in two different categories: structural deformity, when the main driver of the observed deformity is a fixed and stiff alteration of the spinal segments, and compensatory deformity, which includes cases where the observed deformity is due to focal abnormalities. This last category comprises, but is not limited to, spinal stenosis, spondylolisthesis, disc herniation, infection or tumor, hip disease or neurological disease (such as Parkinson's disease). METHOD Narrative review article. RESULTS We analyzed the focal diseases of the spine that may cause a compensatory deformity inducing adaptation in the unaffected part of the spine. CONCLUSION The compensatory mechanisms involved in adaptive deformity represent an attempt to maintain a global alignment, to escape from pain or to control body posture. These slides can be retrieved under Electronic Supplementary material.
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Affiliation(s)
- Andrea Redaelli
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Pedro Berjano
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Max Aebi
- IRCCS Istituto Ortopedico Galeazzi, Gspine4, via Riccardo Galeazzi 4, 20161, Milan, Italy
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De la Garza Ramos R, Goodwin CR, Jain A, Martinez-Ramirez D, Karikari IO, Sciubba DM. Inpatient morbidity after spinal deformity surgery in patients with movement disorders. JOURNAL OF SPINE SURGERY 2017; 3:601-608. [PMID: 29354738 DOI: 10.21037/jss.2017.11.09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background To investigate the inpatient perioperative morbidity rate of patients with movement disorders (MD) after spinal deformity surgery. Methods The Nationwide Inpatient Sample database from 2002 to 2011 was queried to identify adult patients with MD who underwent spinal deformity surgery. Complication rates were compared between patients with MD and controls. A multiple logistic regression analysis was conducted to assess the effect of MD on outcome. Results A total of 365 patients with MD (3.3%) were identified among 11,043 patients undergoing surgery for spinal deformity. Patients with MD were on average 8 years older than the control group (67 vs. 59 years of age, P<0.001). The complication rate was 55.1% for patients with MD and 43.7% for patients without MD (P<0.001). The most common complication was acute post-hemorrhagic anemia, which occurred in 31.9% of all patients (41.6% in MD patients and 31.5% in the control group, P<0.001). Other complications that were more common in patients with MD included delirium (P<0.001), acute kidney injury (P=0.032), and pulmonary embolism (P=0.014). After controlling for patient age, sex, osteoporosis, complex procedures, fusion to the lumbosacral spine, use of bone morphogenetic protein, and use of blood transfusion, patients with MD were 1.3 times more likely to develop a complication compared to patients without MD [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.02-1.59; P=0.032] on multiple logistic regression analysis. No significant difference in hospital stay was observed. Conclusions Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of complications compared to patients without these disorders.
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Affiliation(s)
- Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
| | - C Rory Goodwin
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Martinez-Ramirez
- Department of Neurology, University of Florida Health Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel M Sciubba
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, USA
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18
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Baker JF, McClelland S, Line BG, Smith JS, Hart RA, Ames CP, Shaffrey C, Bess S. In-Hospital Complications and Resource Utilization Following Lumbar Spine Surgery in Patients with Parkinson Disease: Evaluation of the National Inpatient Sample Database. World Neurosurg 2017; 106:470-476. [DOI: 10.1016/j.wneu.2017.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 12/12/2022]
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Abstract
Parkinson disease (PD) is increasingly prevalent in the aging population. Spine disorders in patients with PD may be degenerative in nature or may arise secondary to motor effects related to the parkinsonian disease process. Physicians providing care for patients with PD and spine pathologies must be aware of several factors that affect treatment, including the patterns of spinal deformity, complex drug interactions, and PD-associated osteoporosis. Following spine surgery, complication rates are higher in patients with PD than in those without the disease. Literature on spine surgery in this patient population is limited by small cohort size, the heterogeneous patient population, and variable treatment protocols. However, most studies emphasize the need for preoperative optimization of motor control with appropriate medications and deep brain stimulation, as well as consultation with a movement disorder specialist. Future studies must control for confounding variables, such as the type of surgery and PD severity, to improve understanding of spinal pathology and treatment options in this patient population.
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20
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Body Posture, Postural Stability, and Metabolic Age in Patients with Parkinson's Disease. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3975417. [PMID: 28740852 PMCID: PMC5504934 DOI: 10.1155/2017/3975417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/19/2017] [Accepted: 05/22/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The study aims to analyze the relationship between body posture and composition, as well as postural stability in Parkinson's disease patients. MATERIAL AND METHODS 32 people were evaluated. The study was conducted in the Laboratory of Posturology at Jan Kochanowski University in Kielce (Poland). Body posture was examined using the optoelectronic body posture Formetric Diers Method III 4D. Postural stability was evaluated using the Biodex Balance System platform. Body composition was assessed with the method of bioelectrical impedance analysis using the Tanita MC 780 MA analyzer. RESULTS 11 patients (34.37%) had hyperkyphosis, 10 (31.25%) hyperlordosis, and 3 (9.37%) hyperkyphosis-hyperlordosis posture. Scoliosis (>10°) was observed in 28 (87.5%) subjects, whereas 4 (12.5%) presented scoliotic body posture (1-9°). In the examined population, all parameters of postural stability were within normal limits. CONCLUSIONS A significant positive correlation was observed between surface rotation (°), General Stability Index (r = 0.4075, p = 0.0206), and Anteroposterior Stability Index (r = 0.3819, p = 0.0310). There was also a significant positive correlation between surface rotation (+max) (°), General Stability Index (r = 0.3526, p = 0.0206), and Anteroposterior Stability Index (r = 0.3873, p = 0.0285). Metabolic age also presented a significant positive correlation between metabolic age and General Stability Index (r = 0.4057, p = 0.0212), as well as Anteroposterior Stability Index (r = 0.3507, p = 0.0490).
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21
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Complications and operative spine fusion construct length in Parkinson's disease: A nationwide population-based analysis. J Clin Neurosci 2017; 43:220-223. [PMID: 28599840 DOI: 10.1016/j.jocn.2017.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/21/2017] [Indexed: 12/19/2022]
Abstract
There remains a dearth of information regarding the surgical complications following multilevel spine surgery in Parkinson's disease (PD) patients. This retrospective cohort study was performed to address this issue on a nationwide level using the Nationwide Inpatient Sample from 2001 to 2012. More than 25 postoperative variables were analyzed to assess the impact of fusion construct length on each variable. Subsequently, the same analysis was performed on admissions without PD. 4301 PD patients with spine fusion were identified, of whom 934 (21.7%) underwent fusion of at least three levels; the remaining 3367 underwent fusion of 1-2 levels. Patients with 3+ level fusions were more likely to suffer paraplegia (P=.001; OR=3.0; 95%CI=1.5-6.1), hematoma/seroma (P=.009; OR=1.9; 95%CI=1.2-3.2), IVC filter placement (P=.018; OR=2.1; 95%CI=1.1-3.9), RBC transfusion (P<.001; OR=3.2; 95%CI=2.7-3.8), PE (P=.027; OR=4.5; 95%CI=1.2-16.9), postoperative shock (P=.023; OR=7.3; 95%CI=1.3-39.6), ARDS (P<.001; OR=4.1; 95%CI=2.7-6.3), VTE (P=.006; OR=2.6; 95%CI=1.3-5.4), acute posthemorrhagic anemia (P<.001; OR=2.0; 95%CI=1.7-2.4), device-related complications (P<.001; OR=3.1; 95%CI=2.3-4.2), and in-hospital mortality (P=.005; OR=3.4; 95%CI=1.5-7.4). 3+ level fusions were also more likely to have LOS>1week (P<.001; OR=2.1; 95%CI=1.8-2.5), and a nonroutine discharge (P=.005; OR=1.9; 95%CI=1.4-2.4). 692,173 non-PD patients with spine fusion were identified; 123,964 (17.9%) underwent 3+ level fusion. Differences between 3+ versus 1-2 level fusions were similar to those in PD patient, but unlike PD patients, postoperative infection was significant while in-hospital mortality, PE and VTE were not. Fusion of at least three levels increased morbidity, mortality, and adverse discharge disposition compared with 1-2 level fusions. Nearly 80% of all spine fusions performed in the United States are fewer than three levels. These findings are worth considering during operative decision-making in both PD and non-PD patients.
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22
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Ye X, Lou D, Ding X, Xie C, Gao J, Lou Y, Cen Z, Xiao Y, Miao Q, Xie F, Zheng X, Wu J, Li F, Luo W. A clinical study of the coronal plane deformity in Parkinson disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1862-1870. [PMID: 28281005 DOI: 10.1007/s00586-017-5018-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 02/12/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postural deformities in the coronal plane were frequent and disabling complications of PD, which reduces the quality of life of patients. This study aimed to garner greater attention to the Parkinson disease (PD)-related postural trunk deviations in the coronal plane by exploring a method for diagnosis because of the lack of any uniform diagnostic criteria and epidemiological studies. It also aimed to provide correlation data in the Chinese PD patients. METHODS In this cross-sectional study, 503 consecutive outpatients with PD were enrolled who underwent standardized clinical evaluation. The study recruited 83 PD patients diagnosed with Pisa syndrome (PS). Scoliosis and coronal imbalance were diagnosed accurately by radiographic data. The PD patients were compared based on the Cobb angle and coronal balance for several demographic and clinical variables. RESULTS PD patients with PS had a prevalence of 16.5%. The prevalence of coronal imbalance and scoliosis was 10.34 and 7.75%, respectively. PD patients with PS were older and had a more severe disease, significantly longer disease duration and treatment duration, and reduced quality of life. The most important finding was that the different morphology of the spinal level had an effect on the severity of coronal balance or Cobb angle. CONCLUSIONS The present study indicated that the postural deformities in the coronal plane were related to the morphology of the spinal level, especially the position of the Cobb angle. To benefit the PD patients with PS, the full-length standing spine radiographs should be performed as early as possible.
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Affiliation(s)
- Xiaoyun Ye
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Danning Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xueping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Haining People's Hospital, Jiaxing, China
| | - Chaoyan Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Beilun People's Hospital, Ningbo, China
| | - Jixiang Gao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuting Lou
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhidong Cen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pediatrics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuxiang Xiao
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qianzhuang Miao
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Pharmacy, Fenghua Hospital, Fenghua, Ningbo, China
| | - Fei Xie
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaosheng Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianxin Wu
- Department of Neurology, No. 117 Hospital of People's Liberation Army, Hangzhou, China
| | - Fangcai Li
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Wei Luo
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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Bao H, Yan P, Qiu Y, Liu Z, Zhu F. Coronal imbalance in degenerative lumbar scoliosis: Prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J 2017; 98-B:1227-33. [PMID: 27587525 DOI: 10.1302/0301-620x.98b9.37273] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022]
Abstract
AIMS There is a paucity of information on the pre-operative coronal imbalance in patients with degenerative lumbar scoliosis (DLS) and its influence on surgical outcomes. PATIENTS AND METHODS A total of 284 DLS patients were recruited into this study, among whom 69 patients were treated surgically and the remaining 215 patients conservatively Patients were classified based on the coronal balance distance (CBD): Type A, CBD < 3 cm; Type B, CBD > 3 cm and C7 Plumb Line (C7PL) shifted to the concave side of the curve; Type C, CBD > 3 cm and C7PL shifted to the convex side. RESULTS A total of 99 of the 284 (34.8%) patient presented with a pre-operative coronal imbalance (mean CBD: 48.5, standard deviation 18.7 mm). More patients with a Type B malalignment were observed than with a Type C malalignment (62 versus 37). A total of 21 pf the 69 (30.4%) surgically treated patients had a post-operative coronal imbalance, which was found to be more prevalent in Type C patients (p < 0.001). At follow-up, less improvement was observed in terms of Short Form-36 Physical Component Score and visual analogue score for back pain (p = 0.034 and 0.025, respectively) in Type C patients. CONCLUSION This study shows that patients with Type C coronal malalignment may be at greater risk of post-operative coronal imbalance following posterior osteotomy. Cite this article: Bone Joint J 2016;98-B:1227-33.
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Affiliation(s)
- H Bao
- Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - P Yan
- Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Y Qiu
- Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - Z Liu
- Nanjing Drum Tower Hospital, 321 Zhongshan Road, Nanjing, 210008, China
| | - F Zhu
- Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, Hong Kong, China
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Watanabe K, Hirano T, Katsumi K, Ohashi M, Shoji H, Hasegawa K, Yamazaki A, Ishikawa A, Koike R, Endo N, Nishizawa M, Shimohata T. Characteristics of spinopelvic alignment in Parkinson's disease: Comparison with adult spinal deformity. J Orthop Sci 2017; 22:16-21. [PMID: 27964875 DOI: 10.1016/j.jos.2016.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/27/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The characteristics and pathogenesis of spinopelvic alignment in Parkinsons's disease (PD) patients-including differences compared to non-PD subjects and their relationships with the severity of PD-have not been clarified. The aim of this study was to investigate the characteristics of spinopelvic alignment in patients with PD. METHODS Forty-eight PD patients complaining of chronic low back pain were included (PD group). The PD condition, determined using the Hoehn and Yahr (H&Y) stage and Unified Parkinson Disease Rating Scale (UPDRS) score; radiographic spinopelvic alignment; lumbar range of motion (ROM); and low back pain-related quality of life assessments were evaluated. Fifty age- and sex-matched patients with adult spinal deformities were included as controls (ASD group). RESULTS The spinopelvic alignments of the PD/ASD groups demonstrated sagittal vertical axes of 120.9/106.3 mm and pelvic incidences of 49.7/52.9°, with no significant differences. Conversely, there were significant differences in the thoracic kyphosis (TK; 27.6/16.7°), lumbar lordosis (-22.7/-7.9°), and pelvic tilt (25.3/34.4°) (all, p < 0.05). With regard to correlations with the PD condition, the H&Y stage demonstrated significant correlations with the sagittal vertical axis, thoracolumbar kyphosis, and lumbar ROM (all, p < 0.05), and the UPDRS score tended to correlate with the TK and thoracolumbar kyphosis (both, p < 0.01). CONCLUSION Characteristic spinal conditions in PD exist, with progressed PD condition causing stooped posture with increased thoracic or thoracolumbar kyphosis and decreased lumbar ROM; moreover, global sagittal malalignment progresses without sufficient compensatory mechanisms such as loss of TK and pelvic retroversion.
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Affiliation(s)
- Kei Watanabe
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan.
| | - Toru Hirano
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Keiichi Katsumi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Masayuki Ohashi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Hirokazu Shoji
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan
| | | | - Akiyoshi Yamazaki
- Department of Orthopedic Surgery, Spine Center, Niigata Central Hospital, Japan
| | - Atsushi Ishikawa
- Department of Neurology, Brain Disease Center Agano Hospital, Japan
| | - Ryoko Koike
- Department of Neurology, Nishi-Niigata Chuo National Hospital, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Niigata, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata City, Niigata, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Brain Research Institute, Niigata University, Niigata City, Niigata, Japan
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McClelland S, Baker JF, Smith JS, Line BG, Errico TJ, Ames CP, Bess RS. Impact of Parkinson’s disease on perioperative complications and hospital cost in multilevel spine fusion: A population-based analysis. J Clin Neurosci 2017; 35:88-91. [DOI: 10.1016/j.jocn.2016.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/04/2016] [Indexed: 01/01/2023]
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Kapetanakis S, Giovannopoulou E, Thomaidis T, Charitoudis G, Pavlidis P, Kazakos K. Transforaminal Percutaneous Endoscopic Discectomy in Parkinson Disease: Preliminary Results and Short Review of the Literature. KOREAN JOURNAL OF SPINE 2016; 13:144-150. [PMID: 27799995 PMCID: PMC5086467 DOI: 10.14245/kjs.2016.13.3.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022]
Abstract
Objective To study the effectiveness of Transforaminal Percutaneous Endoscopic Discectomy (TPED) for lumbar disc herniation in patients with Parkinson disease (PD). Methods Fifteen patients diagnosed with PD and lumbar disc hernia were recruited to the study. All patients underwent TPED. Mean age was 61.27±6 years, with 8 male (53.3%) and 7 female patients (46.7%). Level of operation was L3-4 (33.3%), L4-5 (33.3%) and L5-S1 (33.3%). Visual analogue scale (VAS) for leg pain and Oswestry Disabillity Index (ODI) for back pain, as well as the Medical Outcomes Study Questionnaire Short-Form 36 Health Survey (SF-36) for health-related quality of life (HRQoL) were assessed right before surgery and at 6 weeks, 3, 6, and 12 months after surgery. Results VAS and ODI showed significant (p<0.005) reduction one year after TPED, with a percentage improvement of 83.9% and 79.4%, respectively. Similarly, all aspects of quality of life (SF-36) were significantly (p<0.005) improved 1 year after the procedure. Bodily pain and role physical demonstrated the highest increase followed by role emotional, physical function, social function, vitality, mental health, and general health. Beneficial impact of TPED on clinical outcome and HRQoL was independent of gender and operated level. Conclusion TPED is effective in reducing lower limb symptoms and low back pain in patients with lumbar disc hernia, suffering from PD. Positive effect of endoscopy is, also, evident in HRQoL of those patients one year after the procedure.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Eirini Giovannopoulou
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Triphonas Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - George Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kazakos
- Department of Orthopaedic Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Ha Y, Oh JK, Smith JS, Ailon T, Fehlings MG, Shaffrey CI, Ames CP. Impact of Movement Disorders on Management of Spinal Deformity in the Elderly. Neurosurgery 2015; 77 Suppl 4:S173-85. [DOI: 10.1227/neu.0000000000000940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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