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Gandolfi M, Geroin C, Imbalzano G, Camozzi S, Menaspà Z, Tinazzi M, Alberto Artusi C. Treatment of axial postural abnormalities in parkinsonism disorders: A systematic review of pharmacological, rehabilitative and surgical interventions. Clin Park Relat Disord 2024; 10:100240. [PMID: 38596537 PMCID: PMC11002662 DOI: 10.1016/j.prdoa.2024.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024] Open
Abstract
Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Italy
- Neurorehabilitation Unit, AOUI Verona, Italy
| | - Christian Geroin
- Department of Surgery, Dentistry, Paediatric and Gynaecology, University of Verona, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Serena Camozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Zoe Menaspà
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carlo Alberto Artusi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Turin, Italy
- SC Neurologia 2U, AOU Città della Salute e della Scienza, Turin, Italy
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Somma T, Fellico F, De Rosa A, Bocchino A, Corvino S, Milone A, Cappabianca P, Esposito F. Impact of deep brain stimulation therapy on the vertebral sagittal balance in Parkinson's disease patients. Neurosurg Rev 2023; 47:7. [PMID: 38063935 DOI: 10.1007/s10143-023-02243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Abstract
Parkinson's disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity, and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorsal-lateral region of the STN, on the sagittal balance of patients affected by PD. Among all patients that have undergone DBS procedures in our institution, we selected eight subjects, four females and four males, with selective targeting on the dorsal-lateral region of the subthalamic nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months postoperatively were carried out. Comparison of preoperative and postoperative spine X-ray data showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Deep brain stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson's disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.
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Affiliation(s)
- Teresa Somma
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Fabrizio Fellico
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea De Rosa
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea Bocchino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Antonio Milone
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy.
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Berreta RS, Zhang H, Alsoof D, Khatri S, Casey J, McDonald CL, Diebo BG, Kuris EO, Basques BA, Daniels AH. Adult Spinal Deformity Correction in Patients with Parkinson Disease: Assessment of Surgical Complications, Reoperation, and Cost. World Neurosurg 2023; 178:e331-e338. [PMID: 37480985 DOI: 10.1016/j.wneu.2023.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Parkinson disease (PD) is a neurodegenerative disorder that manifests with postural instability and gait imbalance. Correction of spinal deformity in patients with PD presents unique challenges. METHODS The PearlDiver database was queried between 2010 and 2020 to identify adult patients with spinal deformity before undergoing deformity correction with posterior spinal fusion. Two cohorts were created representing patients with and without a preoperative diagnosis of PD. Outcome measures included reoperation rates, surgical technique, cost, surgical complications, and medical complications. Multivariable logistic regression adjusting for Charlson Comorbidity Index, age, gender, 3-column osteotomy, pelvic fixation, and number of levels fused was used to assess rates of reoperation and complications. RESULTS In total, 26,984 patients met the inclusion criteria and were retained for analysis. Of these patients, 725 had a diagnosis of PD before deformity correction. Patients with PD underwent higher rates of pelvic fixation (odds ratio [OR], 1.33; P < 0.001) and 3-column osteotomies (OR, 1.53; P < 0.001). On adjusted regression, patients with PD showed increased rates of reoperation at 1 year (OR, 1.37; P < 0.001), 5 years (OR, 1.32; P < 0.001), and overall (OR, 1.33; P < 0.001). Patients with PD also experienced an increased rate of medical complications within 30 days after deformity correction including deep venous thrombosis (OR, 1.60; P = 0.021), pneumonia (OR, 1.44; P = 0.039), and urinary tract infections (OR, 1.54; P < 0.001). Deformity correction in patients with PD was associated with higher 90-day cost (P = 0.007). CONCLUSIONS Patients with PD undergoing long fusion for deformity correction are at significantly increased risk of 30-day medical complications and revision procedures after 1 year, controlling for comorbidities, age, and invasiveness. Surgeons should consider the risk of complications, subsequent revision procedures, and increased cost.
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Affiliation(s)
| | - Helen Zhang
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Surya Khatri
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jack Casey
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Eren O Kuris
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Bryce A Basques
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopedics, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
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Watanabe G, Palmisciano P, Conching A, Ogasawara C, Ramanathan V, Alfawares Y, Bin-Alamer O, Haider AS, Abou-Al-Shaar H, Lall R, Aoun SG, Umana GE. Degenerative Spine Surgery in Patients with Parkinson Disease: A Systematic Review. World Neurosurg 2023; 169:94-109.e2. [PMID: 36273726 DOI: 10.1016/j.wneu.2022.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Parkinson disease (PD) has been recognized as responsible for concurrent spinal disorders. Surgical correction may be necessary, but the complexity of such fragile patients may require specific considerations. We systematically reviewed the literature on degenerative spine surgery in patients with PD. METHODS PubMed, Scopus, Web of Science, and Cochrane were searched according to the PRISMA guidelines to include studies reporting clinical data of patients with PD undergoing degenerative spine surgery. Clinical characteristics, treatment protocols, and outcomes were analyzed. RESULTS We included 22 articles comprising 442 patients (61.5% female). Mean age was 66.9 ± 3.5 years (range, 41-83 years). Mean PD duration and modified Hoehn and Yahr stage were 4.46 ± 2.39 years and 2.3 ± 0.8, respectively. Operation types included fusion (55.3%) and decompression (41.6%). Mean operated spine levels were 6.0 ± 5.08. A total of 377 postoperative complications occurred in 34.6% patients, categorized into mechanical failure (58.0%), infection (15.1%), or neurologic (10.7%). Of patients, 31.8% required surgical revisions, with an average of 1.88 ± 1.03 revisions per patient. The average normalized presurgery, postsurgery, and final aggregate numeric patient outcome scores were 0.37 ± 0.13, 0.63 ± 0.18, and 0.61 ± 0.19, respectively, with a score of 0 and 1 representing the worst and best possible score. CONCLUSIONS Degenerative spine surgery in patients with PD is challenging, with complications and revisions occurring in up to a third of treated patients. Surgery should be offered when other treatment options have proved ineffective and is typically reserved for patients with myelopathy or significant disability. Successful outcomes depend on strong interdisciplinary support to control the movement disorder before and after surgery.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andie Conching
- John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii, USA
| | - Christian Ogasawara
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Yara Alfawares
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Othman Bin-Alamer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rishi Lall
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Salah G Aoun
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
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5
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Spindler P, Alzoobi Y, Kühn AA, Faust K, Schneider GH, Vajkoczy P. Deep brain stimulation for Parkinson's disease-related postural abnormalities: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:3083-3092. [PMID: 35790655 PMCID: PMC9492622 DOI: 10.1007/s10143-022-01830-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/28/2022] [Indexed: 02/03/2023]
Abstract
Deep brain stimulation (DBS) has become a well-established treatment modality for Parkinson's disease (PD), especially regarding motor fluctuations, dyskinesias, and tremor. Although postural abnormalities (i.e., Camptocormia [CC] and Pisa syndrome [Pisa]) are known to be a major symptom of PD as well, the influence of DBS on postural abnormalities is unclear. The objective of this study is to analyze the existing literature regarding DBS for PD-associated postural abnormalities in a systematic review and meta-analysis. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review and meta-analysis of 18 studies that reported the effect of DBS regarding postural abnormalities. After screening of 53 studies, a total of 98 patients (44 female, 53 males, 1 not reported; mean age: 62.3, range 30-83 years) with postural abnormalities (CC n = 98; Pisa n = 11) were analyzed from 18 included studies. Of those patients, 94.9% underwent STN-DBS and 5.1% had GPi as DBS target area. A positive outcome was reported for 67.8% with CC and 72.2% with Pisa. In the meta-analysis, younger age and lower pre-operative UPDRS-III (ON/OFF) were found as positive predictive factors for a positive effect of DBS. DBS might be a potentially effective treatment option for PD-associated postural abnormalities. However, the level of evidence is rather low, and definition of postoperative outcome is heterogenous between studies. Therefore larger, prospective trials are necessary to give a clear recommendation.
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Affiliation(s)
- Philipp Spindler
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Yasmin Alzoobi
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Andrea A. Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Umakoshi M, Yasuhara T, Morimoto J, Murai S, Sasaki T, Kameda M, Kin K, Miyoshi Y, Date I. Spinal Surgery after Bilateral Subthalamic Stimulation for Patients with Parkinson's Disease: A Retrospective Outcome Analysis of Pain and Functional Control. Neurol Med Chir (Tokyo) 2021; 61:607-618. [PMID: 34408107 PMCID: PMC8531877 DOI: 10.2176/nmc.oa.2021-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Parkinson’s disease (PD) patients often suffer from spinal diseases requiring surgeries, although the risk of complications is high. There are few reports on outcomes after spinal surgery for PD patients with deep brain stimulation (DBS). The objective of this study was to explore the data on spinal surgery for PD patients with precedent DBS. We evaluated 24 consecutive PD patients with 28 spinal surgeries from 2007 to 2017 who received at least a 2-year follow-up. The characteristics and outcomes of PD patients after spinal surgery were compared to those of 156 non-PD patients with degenerative spinal diseases treated in 2013–2017. Then, the characteristics, outcomes, and spinal alignment of PD patients receiving DBS were analyzed in degenerative spinal/lumbar diseases. The mean age at the time of spinal surgery was 68 years. The Hoehn and Yahr score regarding PD was stage 1 for 8 patients, stage 2 for 2 patients, stage 3 for 8 patients, stage 4 for 10 patients, and stage 5 for 0 patient. The median preoperative L-DOPA equivalent daily dose was 410 mg. Thirteen patients (46%) received precedent subthalamic nucleus (STN) DBS. Lumbar lesions with pain were common, and operation and anesthesia times were long in PD patients. Pain and functional improvement of PD patients persisted for 2 years after surgery with a higher complication rate than for non-PD patients. PD patients with STN DBS maintained better lumbar lordosis for 2 years after spinal surgery. STN DBS significantly maintained spinal alignment with subsequent pain and functional amelioration 2 years after surgery. The outcomes of spinal surgery for PD patients might be favorably affected by thorough treatment for PD including DBS.
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Affiliation(s)
- Michiari Umakoshi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Jun Morimoto
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kyohei Kin
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yasuyuki Miyoshi
- Department of Neurosurgery, Kawasaki Medical School General Medical Center
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Sapkas G, Ampadiotaki MM, Pallis D, Papadakis M, Halikiopoulos SA, Papadakis S. Complications after Spinal Surgery in Patients with Parkinson’s Disease. Open Orthop J 2021. [DOI: 10.2174/1874325002115010046] [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: 02/22/2023] Open
Abstract
Background:
Several studies have shown that spinal surgeries in patients who suffer from Parkinson’s Disease have a high rate of complications. These patients often need revision surgery.
Objective:
This is a retrospective study involving 21 patients with Parkinson’s Disease. This study aimed to examine the complications after spinal surgery.
Methods:
We studied 21 patients with Parkinson’s Disease retrospectively, who had undergone a previous operation by the same surgeon between 2004 to 2019. There were 11 females and 10 males. The mean age was 71.9 years (range, 52 to 85). However, the initial diagnosis and types of surgery were different. The mean time of follow-up for each patient was 3.6 years (ranging from 2 to 8 years).
Results:
Most of the patients had a post-operative complication within a period of three years. Τhe most common complication was kyphotic deformity and camptocormia. Twelve patients (57.1%) underwent revision surgery, and three patients (14.2%) denied treatment. In four patients (19.04%), kyphotic deformity or stooped posture remained. Only one patient (4.7%) presented with no complication in a follow-up of 8 years.
Conclusion:
Patients with Parkinson’s disease have a high rate of complications after spinal surgery and often need revision surgery. For this literature review, the overall number of patients was 502, and the mean revision rate was 43.6%. The surgeon must inform patients of possible complications, and a thorough post-operative observation must be implemented.
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Multimodal treatment including lumbar facet joint denervation for severe low back pain in patients with neuromuscular disorders. Neurol Sci 2021; 43:593-601. [PMID: 33973077 DOI: 10.1007/s10072-021-05298-9] [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] [Received: 11/12/2020] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Severe low back pain (LBP) is an occasional complaint in patients with neuromuscular disorders (NMDs). Accurate diagnosis and treatment are required to manage LBP; however, the precise pathophysiology differs for each patient. This study aimed to evaluate the efficacy of lumbar facet joint denervation (FJD) and adjunctive modalities in the treatment of LBP in patients with NMD-associated kyphoscoliosis. METHODS A total of 16 patients (22 sites) with NMD (bilateral, n = 6; unilateral, n = 10) and LBP treated with lumbar FJD were evaluated. The patients were divided into two groups: those treated with FJD alone (group 1) and those treated with multimodal treatment, including FJD along with radiofrequency ablation for sacroiliac joint pain, piriform muscle block, botulinum toxin injection into the paraspinal muscles, spinal cord stimulation, or any of their combinations (group 2). All patients were followed up for 48 weeks postoperatively. The two groups were compared with respect to the duration required for improvements in LBP by more than 50% (numerical rating scale ≤ 5). RESULTS There was no significant difference between the groups regarding the age, duration since the onset of Parkinson's syndrome, and radiographic analysis. The effective period of improved pain was greater in group 2 than in group 1 (30.7 vs. 8.4 weeks, P < 0.01). CONCLUSIONS Multimodal treatment including FJD is safe and relatively effective in patients with NMD-associated kyphoscoliosis. Hence, it is a potential substitute for conventional spinal fixation surgery, which has a higher risk of complications.
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9
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Lai Y, Song Y, Huang P, Wang T, Wang L, Pan Y, Sun Q, Sun B, Zhang C, Li D. Subthalamic Stimulation for Camptocormia in Parkinson's Disease: Association of Volume of Tissue Activated and Structural Connectivity with Clinical Effectiveness. JOURNAL OF PARKINSONS DISEASE 2021; 11:199-210. [PMID: 33325395 PMCID: PMC7990421 DOI: 10.3233/jpd-202259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been reported to be effective for camptocormia in Parkinson's disease (PD). However, the association between clinical effectiveness and the stimulated volumes or structural connectivity remains unexplored. OBJECTIVE To investigate the effectiveness of STN-DBS for treating camptocormia in PD and its association with volumes of tissue activated (VTA) and structural connectivity. METHODS We reviewed video recordings of patients who had undergone STN-DBS. The total and upper camptocormia (TCC and UCC) angles were measured to quantify changes in camptocormia. The Movement Disorders Society Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III) was used to assess motor symptoms. Pre- and postoperative brain images were collected for modeling volume of VTA and structural connectivity using Lead-DBS software. RESULTS Participants included 36 patients with PD (8 with TCC-camptocormia and 2 with UCC-camptocormia) treated with bilateral STN-DBS. After surgery, patients showed a significant improvement in postural alignment at follow-up (mean follow-up duration: 6.0±2.2 months). In the entire sample, higher structural connectivity to the right supplementary motor area (SMA) and right lateral premotor cortex along the dorsal plane (PMd) was associated with larger postsurgical improvements in axial signs and TCC angles after stimulation was turned on. In patients diagnosed with camptocormia, larger improvement in camptocormia angles after STN-DBS was associated with a larger VTA overlap with STN (R = 0.75, p = 0.032). CONCLUSION This study suggests that both VTA overlap with STN and structural connectivity to cortical motor regions are associated with the effectiveness of STN-DBS for managing camptocormia in PD.
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Affiliation(s)
- Yijie Lai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhai Song
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurosurgery, Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiaotong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingfang Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Lai Y, Song Y, Su D, Wang L, Zhang C, Sun B, Nonnekes J, Bloem BR, Li D. Pallidal stimulation as treatment for camptocormia in Parkinson's disease. NPJ PARKINSONS DISEASE 2021; 7:8. [PMID: 33462205 PMCID: PMC7813849 DOI: 10.1038/s41531-020-00151-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
Camptocormia is a common and often debilitating postural deformity in Parkinson’s disease (PD). Few treatments are currently effective. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) shows potential in treating camptocormia, but evidence remains limited to case reports. We herein investigate the effect of GPi-DBS for treating camptocormia in a retrospective PD cohort. Thirty-six consecutive PD patients who underwent GPi-DBS were reviewed. The total and upper camptocormia angles (TCC and UCC angles) derived from video recordings of patients who received GPi-DBS were used to compare camptocormia alterations. Correlation analysis was performed to identify factors associated with the postoperative improvements. DBS lead placement and the impact of stimulation were analyzed using Lead-DBS software. Eleven patients manifested pre-surgical camptocormia: seven had lower camptocormia (TCC angles ≥ 30°; TCC-camptocormia), three had upper camptocormia (UCC angles ≥ 45°; UCC-camptocormia), and one had both. Mean follow-up time was 7.3 ± 3.3 months. GPi-DBS improved TCC-camptocormia by 40.4% (angles from 39.1° ± 10.1° to 23.3° ± 8.1°, p = 0.017) and UCC-camptocormia by 22.8% (angles from 50.5° ± 2.6° to 39.0° ± 6.7°, p = 0.012). Improvement in TCC angle was positively associated with pre-surgical TCC angles, levodopa responsiveness of the TCC angle, and structural connectivity from volume of tissue activated to somatosensory cortex. Greater improvement in UCC angles was seen in patients with larger pre-surgical UCC angles. Our study demonstrates potential effectiveness of GPi-DBS for treating camptocormia in PD patients. Future controlled studies with larger numbers of patients with PD-related camptocormia should extend our findings.
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Affiliation(s)
- Yijie Lai
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhai Song
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Neurosurgery Department, Shanghai Children's Medical Center Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China
| | - Daoqing Su
- Department of Neurosurgery, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, China
| | - Linbin Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jorik Nonnekes
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain Cognition and Behavior, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behavior, Nijmegen, The Netherlands
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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11
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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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12
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Extensive Spinal Fusion Surgery in Patients With Parkinson Disease or Atypical Parkinsonism: Time Course of Clinical Outcomes in 5 Years Progress Report. Spine (Phila Pa 1976) 2020; 45:E217-E226. [PMID: 31513098 DOI: 10.1097/brs.0000000000003246] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE To clarify the mid-term results of extensive spinal fusion surgery in patients with Parkinson disease (PD) or atypical Parkinsonism, especially with respect to their activities of daily living (ADL) over time SUMMARY OF BACKGROUND DATA.: Postural disorders associated with PD lead to spinal imbalance and deformity, resulting in significant disabilities. Clinical outcomes of extensive fusion surgeries in patients with PD over a medium-term follow-up period are currently unknown. METHODS Patients with PD who underwent extensive fusion surgery more than 5 years prior were included. The patients' backgrounds, surgical and radiographic parameters, perioperative and mechanical complications, and indoor ADL over time were assessed. To assess the activities of severely disabled patients, indoor ADL was classified into four stages: independent; or cane, walker, and wheelchair use. RESULTS Twenty-two patients (mean age, 70.6 yrs) were included. The mean blood loss, duration of surgery, and fusion levels were 2039 mL, 424 minutes, and 11.9 levels, respectively. Sagittal vertical axis improved from 220 mm preoperatively to 95 mm postoperatively. Perioperative complications were observed in 17 cases (77%). Before surgery, 1, 5, 12, and four cases were independent in ADL, T-cane, walker, and wheelchair use, respectively, which improved to seven, four, six, and four, respectively in 1 year. Revision surgeries were performed in eight patients (36%) within 3 years of surgery. In the 3 to 5 years after the surgery, the ADL of nine patients worsened due to deterioration of PD. Fifteen cases were followed up over 5 years, at which one, two, four, and seven cases were independent in ADL, cane, walker, and wheelchair use, respectively. CONCLUSION Surgical intervention in PD patients with spinal deformities leads to good short-term outcomes; however, the patients' conditions deteriorated because of complications within 3 years and worsening of PD over 3 years after the surgery. LEVEL OF EVIDENCE 4.
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Martini ML, Deutsch BC, Neifert SN, Caridi JM. A National Snapshot Detailing the Impact of Parkinson's Disease on the Cost and Outcome Profiles of Fusion Procedures for Cervical Myelopathy. Neurosurgery 2020; 86:298-308. [PMID: 30957147 DOI: 10.1093/neuros/nyz087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies suggest a higher prevalence of cervical deformities in Parkinson's Disease (PD) patients who predispose to cervical myelopathy (CM). Despite the profound effect of CM on function and quality of life, no study has assessed the influence of PD on costs and outcomes of fusion procedures for CM. OBJECTIVE To conduct the first national-level study that provides a snapshot of the current outcome and cost profiles for different fusion procedures for CM in PD and non-PD populations. METHODS Patients with or without PD who underwent cervical decompression and fusion anteriorly (ACDF), posteriorly (PCDF), or both (Frontback), for CM were identified from the 2013 to 2014 National Inpatient Sample using International Classification of Disease codes. RESULTS A total of 75 870 CM patients were identified, with 535 patients (0.71%) also having PD. Although no difference existed between in-hospital mortality rates, overall complication rates were higher in PD patients (38.32% vs 22.05%; P < .001). PD patients had higher odds of pulmonary (P = .002), circulatory (P = .020), and hematological complications (P = .035). Following ACDFs, PD patients had higher odds of complications (P = .035), extended hospitalization (P = .026), greater total charges (P = .003), and nonhome discharge (P = .006). Although PCDFs and Frontbacks produced higher overall complication rates for both populations than ACDFs, PD status did not affect complication odds for these procedures. CONCLUSION PD may increase risk for certain adverse outcomes depending on procedure type. This study provides data with implications in healthcare delivery, policy, and research regarding a patient population that will grow as our population ages and justifies further investigation in future prospective studies.
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Affiliation(s)
- Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian C Deutsch
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Chan AK, Chan AY, Lau D, Durcanova B, Miller CA, Larson PS, Starr PA, Mummaneni PV. Surgical management of camptocormia in Parkinson's disease: systematic review and meta-analysis. J Neurosurg 2019; 131:368-375. [PMID: 30215560 DOI: 10.3171/2018.4.jns173032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/02/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Camptocormia is a potentially debilitating condition in the progression of Parkinson's disease (PD). It is described as an abnormal forward flexion while standing that resolves when lying supine. Although the condition is relatively common, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, the authors systematically reviewed the current surgical management strategies for camptocormia. METHODS PubMed was queried for primary studies involving surgical intervention for camptocormia in PD patients. Studies were excluded if they described nonsurgical interventions, provided only descriptive data, or were case reports. Secondarily, data from studies describing deep brain stimulation (DBS) to the subthalamic nuclei were extracted for potential meta-analysis. Variables showing correlation to improvement in sagittal plane bending angle (i.e., the vertical angle caused by excessive kyphosis) were subjected to formal meta-analysis. RESULTS The query resulted in 9 studies detailing treatment of camptocormia: 1 study described repetitive trans-spinal magnetic stimulation (rTSMS), 7 studies described DBS, and 1 study described deformity surgery. Five studies were included for meta-analysis. The total number of patients was 66. The percentage of patients with over 50% decrease in sagittal plane imbalance with DBS was 36.4%. A duration of camptocormia of 2 years or less was predictive of better outcomes (OR 4.15). CONCLUSIONS Surgical options include transient, external spinal stimulation; DBS targeting the subthalamic nuclei; and spinal deformity surgery. Benefit from DBS stimulation was inconsistent. Spine surgery corrected spinal imbalance but was associated with a high complication rate.
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Affiliation(s)
- Andrew K Chan
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Alvin Y Chan
- 2Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Darryl Lau
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Beata Durcanova
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Catherine A Miller
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Paul S Larson
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Philip A Starr
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; and
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15
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Lizarraga KJ, Fasano A. Effects of Deep Brain Stimulation on Postural Trunk Deformities: A Systematic Review. Mov Disord Clin Pract 2019; 6:627-638. [PMID: 31745470 DOI: 10.1002/mdc3.12829] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/07/2019] [Accepted: 07/19/2019] [Indexed: 12/17/2022] Open
Abstract
Background Deep brain stimulation (DBS) effects on postural deformities are still poorly explored. Methods Systematic review in accord with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines (PRISMA). Results All 38 studies that met predefined eligibility criteria had high risk of bias attributed to retrospective analysis of heterogeneous populations with variable and incompletely reported demographic and clinical characteristics, definitions, outcomes, DBS indications, targets, and settings. Five patient groups were identified in the 35 studies with individual data available: (1) parkinsonian camptocormia (n = 96): 89 patients underwent subthalamic (STN) and 7 globus pallidus pars interna (GPi) DBS. Camptocormia was the indication in 3 patients. After DBS, camptocormia improved in 57 of 96 patients (4.3-100% improvement) and remained stable or worsened in 39 of 96 patients (2-100% worsening). (2) dystonic camptocormia (n = 16): All underwent GPi-DBS. They were younger and with shorter disease duration, but longer deformity duration, compared with parkinsonian camptocormia. After GPi-DBS, camptocormia improved in all patients (50-100% improvement). (3) Parkinsonian Pisa syndrome (n = 14): 11 patients underwent STN-DBS for motor fluctuations whereas Pisa syndrome was the indication for pedunculopontine and GPi-DBS in 2 patients. After DBS, Pisa improved in 10 of 14 patients (33.3-66.7% improvement). (4) Dystonic opisthotonus: 2 young patients remarkably responded to GPi-DBS. (5) Parkinsonian anterocollis: There were variable responses in 3 patients after STN-DBS for motor fluctuations. Conclusions Low-quality level of evidence suggests that dystonic camptocormia and opisthotonus improve after GPi-DBS. Parkinsonian camptocormia, Pisa syndrome, and anterocollis have variable responses, and their dystonic features should be further explored.
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Affiliation(s)
- Karlo J Lizarraga
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.,Motor Physiology and Neuromodulation Program, Division of Movement Disorders, Department of Neurology University of Rochester Rochester New York USA.,Center for Health and Technology (CHeT) University of Rochester Rochester New York USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, Department of Medicine University of Toronto Toronto Ontario Canada.,Krembil Research Institute Toronto Ontario Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA) Toronto Ontario Canada
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16
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Spinal Fusion in Parkinson's Disease Patients: A Propensity Score-Matched Analysis With Minimum 2-Year Surveillance. Spine (Phila Pa 1976) 2019; 44:E846-E851. [PMID: 30817740 DOI: 10.1097/brs.0000000000002998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To compare outcomes and complication rates between patients with and without Parkinson's disease (PD) patients undergoing surgery for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA There is limited literature evaluating the impact of PD on long-term outcomes after thoracolumbar fusion surgery for ASD. METHODS Patients admitted from 2009 to 2011 with diagnoses of ASD who underwent any thoracolumbar fusion procedure with a minimum 2-year follow-up surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. A 1:1 propensity score-match by age, Deyo score, and number of fused vertebral levels was conducted before comparing surgical outcomes of patients with ASD with and without PD. Univariate analysis compared demographics, complications, and subsequent revision. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes (covariates: age, sex, Deyo Index score, and PD diagnosis). RESULTS A total of 576 propensity score-matched patients were identified (PD: n = 288; no-PD: n = 288), with a mean age of 69.7 years (PD) and 70.2 years (no-PD). Each cohort had comparable distributions of age, sex, race, insurance provider, Deyo score, and number of levels fused (all P > 0.05). Patients with PD incurred higher total charges across ASD surgery-related visits ($187,807 vs. $126,610, P < 0.001), yet rates of medical complications (35.8% PD vs. 34.0% no-PD, P = 0.662) and revision surgery (12.2% vs. 10.8%, P > 0.05) were comparable. Postoperative mortality rates were comparable between PD and no-PD cohorts (2.8% vs. 1.4%, P = 0.243). Logistic regression identified nine-level or higher spinal fusion as a significant predictor for an increase in total complications (odds ratio = 5.64); PD was not associated with increased odds of any adverse outcomes. CONCLUSION Aside from higher hospital charges incurred, patients with PD experienced comparable overall complication and revision rates to a propensity score-matched patient cohort without PD from the general population undergoing thoracolumbar fusion surgery. These results can support management of concerns and postoperative expectations in this patient cohort. LEVEL OF EVIDENCE 3.
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17
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Long Term Outcomes and Effects of Surgery on Degenerative Spinal Deformity: A 14-Year National Cohort Study. J Clin Med 2019; 8:jcm8040483. [PMID: 30974773 PMCID: PMC6518357 DOI: 10.3390/jcm8040483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Degenerative spinal deformity (DSD) has become a prevalent cause of disability and pain among the aging population worldwide. Though surgery has emerged as a promising option for DSD, the natural course, outcomes, and effects of surgery on DSD have remained elusive. This cohort study used a national database to comprehensively follow up patients of DSD for all-cause mortality, respiratory problems, and hip fracture-related hospitalizations. All patients were grouped into an operation or a non-operation group for comparison. An adjustment of demographics, comorbidities, and propensity-score matching was conducted to ameliorate confounders. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were also applied. The study comprised 21,810 DSD patients, including 12,544 of the operation group and 9266 of the non-operation group. During the 14 years (total 109,591.2 person-years) of follow-up, the operation group had lower mortality (crude hazard ratio = 0.40), lower respiratory problems (cHR = 0.45), and lower hip fractures (cHR = 0.63) than the non-operation group (all p < 0.001). After adjustment, the risks for mortality and respiratory problems remained lower (adjusted HR = 0.60 and 0.65, both p < 0.001) in the operation than the non-operation group, while hip fractures were indifferent (aHR = 1.08, p > 0.05). Therefore, surgery for DSD is invaluable since it could reduce the risks of mortality and of hospitalization for respiratory problems.
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18
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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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19
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Scemama C, Mangone G, Bonaccorsi R, Pascal-Moussellard H. Functional results and patient satisfaction after long fusion for spinal deformity in Parkinson's disease. Orthop Traumatol Surg Res 2018; 104:417-420. [PMID: 29474946 DOI: 10.1016/j.otsr.2017.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with Parkinson's disease often present abnormal posture or severe sagittal malalignment, causing significant disability. Surgical fusion is these cases shows high rates of complications, but may nevertheless provide functional benefit; however, this remains to be assessed. HYPOTHESIS Long fusion for patients with Parkinson's disease and postural disorder could alleviate disability despite the high risk of complications. METHODS We retrospectively reviewed 18 Parkinson patients treated by long fusion for spinal deformity. Functional results on the Oswestry Disability Index (ODI) and patient satisfaction were assessed at a minimum 2 years' follow-up. Predictive factors for good outcome were analyzed. RESULTS Median follow-up was 44.4 months (IQR, 36-62.4 months). ODI showed significant improvement, from 64 (IQR, 59-77) preoperatively to 49 (IQR, 40-57) at last follow-up (p=0.0014). Fifteen patients (83%) were very satisfied (n=5) or satisfied (n=10) with the procedure. On multivariate analysis, only age was significantly associated with improvement in ODI at last follow-up (estimate: -9.8; p=0.5). DISCUSSION Although long spinal fusion involves a high risk of complications in Parkinson's patients, the improvement in autonomy and patient satisfaction should be borne in mind before rejecting surgery, especially with motivated patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- C Scemama
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Pitié Salpétrière, Université Pierre et Marie Curie, 83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - G Mangone
- Centre d'Investigation Clinique, CR-ICM, INSERM UMRS 1127, CNRS UMR 7225, Université Pierre et Marie Curie, 83 Boulevard de l'Hôpital, 75013 Paris, France
| | - R Bonaccorsi
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Pitié Salpétrière, Université Pierre et Marie Curie, 83 Boulevard de l'Hôpital, 75013 Paris, France
| | - H Pascal-Moussellard
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Pitié Salpétrière, Université Pierre et Marie Curie, 83 Boulevard de l'Hôpital, 75013 Paris, France
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20
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Ruttiman R, Eltorai AEM, Daniels AH. Etiology and Management of Spinal Deformity in Patients With Parkinson's Disease. Int J Spine Surg 2018; 12:15-21. [PMID: 30280078 DOI: 10.14444/5003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Patients with Parkinson's disease (PD) commonly develop severe spinal deformity, including scoliosis, antecollis, camptocormia, and Pisa syndrome. The etiology of PD-associated spinal deformity is not completely understood and in most cases is likely due to multiple interrelated factors, including central dystonia and focal myopathy. Once spinal deformity has occurred, surgery is often the only modality that can correct the condition, although control of the movement disorder through medication and deep brain stimulation may slow progression. Advances in spinal instrumentation and deformity correction techniques have improved the outcomes of PD spinal deformity patients, though complications and revision surgery rates remain high. Surgical intervention is reserved for individuals who are physiologically healthy and whose condition is refractory to nonoperative management and follows similar treatment principles as other causes of neuromuscular scoliosis/kyphosis. Spinal deformity patients with PD are optimally treated by spinal deformity surgeons who are familiar with the unique needs of PD patients, with vigilant preoperative and postoperative treatment of their movement disorder and bone density.
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Affiliation(s)
- Roy Ruttiman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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21
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Miyashita T, Ataka H, Nakata Y, Kato K, Tanno T. Good clinical outcomes in patients with osteoporotic vertebral collapse after spinal fusion in preoperative neutral alignment fixed in the lateral decubitus position. J Orthop Sci 2017; 22:1146-1150. [PMID: 27142244 DOI: 10.1016/j.jos.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/20/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Tomohiro Miyashita
- Spine Center, Matsudo City Hospital, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan.
| | - Hiromi Ataka
- Spine Center, Matsudo Orthopaedic Hospital, 1-161 Asahi-cho, Matsudo, Chiba, 271-0043, Japan
| | - Yoshinori Nakata
- Nakata Orthopaedic Clinic, 3F Nakayama Medical Square, 4-22-10 Motonakayama, Funabashi, Chiba, 273-0035, Japan
| | - Kei Kato
- Spine Center, Matsudo City Hospital, 4005 Kamihongo, Matsudo, Chiba, 271-8511, Japan
| | - Takaaki Tanno
- Spine Center, Matsudo Orthopaedic Hospital, 1-161 Asahi-cho, Matsudo, Chiba, 271-0043, Japan
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22
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Lee KH, Kim JM, Kim HS. Back Extensor Strengthening Exercise and Backpack Wearing Treatment for Camptocormia in Parkinson's Disease: A Retrospective Pilot Study. Ann Rehabil Med 2017; 41:677-685. [PMID: 28971053 PMCID: PMC5608676 DOI: 10.5535/arm.2017.41.4.677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effect of a conservative treatment regime in Parkinson's disease patients with camptocormia. Methods Nine patients with Parkinson's disease were included in a retrospective pilot study of the value of back extensor strengthening exercise. Six inpatients received a 30-minute treatment, twice daily for 5 weeks, being treated on average for 34 days; while three outpatients visited the clinic and were educated for home exercise and backpack wearing treatment. Outpatients should be scheduled to visit the outpatient department to check physical status every 2–4 weeks for an average of 3 months. Results All patients except one showed statistically significant improvements in activities of daily living (ADL) and motor symptoms, as measured by flexion angle at standing posture, Unified Parkinson's Disease Rating Scale (UPDRS) II and III, and modified Hoehn-Yahr staging. Conclusion Conservative treatment is effective in postural correction of camptocormia in Parkinson's disease, as well as improvement in ADL and motor symptoms.
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Affiliation(s)
- Kun Hee Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jong Moon Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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23
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Xiao R, Miller JA, Lubelski D, Mroz TE, Benzel EC, Krishnaney AA, Machado A. Clinical Outcomes Following Surgical Management of Coexisting Parkinson Disease and Cervical Spondylotic Myelopathy. Neurosurgery 2017; 81:350-356. [PMID: 28327909 DOI: 10.1093/neuros/nyw043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 09/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Distinguishing the causes of weakness and gait instability in patients with Parkinson disease (PD) and cervical spondylotic myelopathy (CSM) is a diagnostic and therapeutic challenge due to symptomatic similarities. No study has reported outcomes following decompression in patients with PD and CSM. OBJECTIVE To report outcomes following cervical decompression for patients with coexisting PD and CSM. METHODS A retrospective matched cohort study of all patients with PD and CSM undergoing cervical decompression at a tertiary-care center between January 1996 and December 2014 was conducted. PD patients were matched to patients with CSM alone by age, gender, American Society of Anesthesiologists classification, and operative parameters. Myelopathy was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) scales. The effect of PD on mJOA was modeled using multivariable regression. RESULTS Twenty-one matched pairs were included. PD patients experienced poorer improvement in Nurick (0.0 vs -1.0, P < .01) and mJOA (0.9 vs 2.5, P < .01) composite scores. However, no significant changes in absolute improvement in the upper extremity motor, upper extremity sensory, or sphincter mJOA components were observed. Multivariable regression identified PD as a significant predictor of decreased improvement in mJOA (β = -0.89, P < .01) and failure to achieve a minimal clinically important difference in change in mJOA (OR 0.18, P = .03). CONCLUSION This study is the first to characterize outcomes following cervical decompression in patients with PD and CSM. PD patients experienced symptomatic improvement but less overall improvement in myelopathy compared to controls. However, PD patients demonstrated improvement in upper extremity motor, upper extremity sensory, and sphincter symptoms no worse than control patients.
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Affiliation(s)
- Roy Xiao
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jacob A Miller
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Lubelski
- Department of Neurological Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Thomas E Mroz
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Edward C Benzel
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ajit A Krishnaney
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Andre Machado
- Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.,Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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24
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Metta V, Sanchez TC, Padmakumar C. Osteoporosis: A Hidden Nonmotor Face of Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:877-890. [PMID: 28805587 DOI: 10.1016/bs.irn.2017.05.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoporosis is a "hidden nonmotor face" of Parkinson's disease and a cause of considerable morbidity in the older general population and in Parkinson's disease patients. Some regard this as a "hidden epidemic." Women are overrepresented and have considerable problems related to osteoporosis. In general osteoporosis leads to reduced mobility aggravating the motor syndrome of PD. The nonmotor aspects and impact of osteoporosis in PD have remained unexplored. Possible nonmotor consequences include a range of pain syndromes related to local pain, fractures, falls, and injuries as well as pathological fractures and radiculopathy. In addition depression, sleep dysfunction, dementia, as well as fear of falling also complicate the clinical picture. Quality of life deteriorates both for the patient and career. Pathways of care do not always include assessments for osteoporosis and needs to become obligatory particularly in older female PD patients. Active management strategies then need to be undertaken for osteoporosis in PD. Related motor and nonmotor consequences also highlight the importance of multidisciplinary treatment in PD particularly when dealing with osteoporosis.
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Affiliation(s)
- Vinod Metta
- Imperial College Hospitals NHS, London, United Kingdom; University College London, London, United Kingdom.
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25
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Abstract
STUDY DESIGN A multicenter, retrospective study. OBJECTIVE To identify the factors that affect surgery-related complications and to clarify the surgical strategy for treating lumbar disorders in Parkinson disease (PD). SUMMARY OF BACKGROUND DATA Previous studies have reported a high complication rate for spinal surgery in patients with PD. Because of the limited number of studies, there are no guidelines for spinal surgery for PD patients. METHODS We retrospectively reviewed the records for 67 PD patients who underwent lumbar spinal surgery. The patients were divided into 3 groups: 12 patients underwent laminectomy (Laminectomy), 24 underwent fusion surgery (Fusion) for lumbar canal stenosis, and 31 underwent corrective surgery for spinal deformity (Deformity). We assessed surgery-related complications in each group. The Cox proportional hazards model was used to identify the factors that predicted surgical failure. RESULTS The percentages of patients who experienced failure of the initial surgery were 33.3% in the Laminectomy group, 45.8% in the Fusion group, and 67.7% in the Deformity group. The rates of implant failure were high in the Fusion and Deformity groups (33.3% and 38.7%, respectively). The Deformity group had a high rate of postoperative fracture (41.9%). These complications occurred at the most caudal site within a year after surgery and resulted in progression of kyphotic deformity. Multivariate analysis revealed that preoperative lumbar lordosis angle (LL) (per -1 degree) was associated with a failure of the initial surgery (hazard ratio, 1.024; 95% confidence interval, 1.008-1.04; P=0.003). CONCLUSIONS We have demonstrated that a small preoperative LL increases the risk for failure of the initial surgery. Attaining and maintaining the proper lumbar lordosis with rigid fixation may be necessary in PD patients with a small preoperative LL.
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Evolution and complications after surgery for spine deformation in patients with Parkinson's disease. Orthop Traumatol Surg Res 2017; 103:517-522. [PMID: 28285031 DOI: 10.1016/j.otsr.2016.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 11/10/2016] [Accepted: 12/15/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical treatment of spinal deformity is high risk in patients suffering from Parkinson's disease (PD). Several series have already reported a high rate of complications. However, none of these studies included more than 40 patients and none of the risk factors of complications were described. The aim of this study was to describe the rate and risk factors of revision surgery as well as the clinical outcome at the last visit in a large multicenter study of PD patients operated for spinal deformities. METHODS A multicenter retrospective study included arthrodesis for spinal deformity in patients with PD. Clinical and surgical data including revision surgeries were collected. Assessment of functional outcomes at last follow-up was classified in 3 grades and spinal balance was assessed on anteroposterior and lateral plain X-rays of the entire spine. RESULTS Forty-eight patients were included. Median age was 67 years old (range 41-80). Median follow-up was 27 months. The rate of surgical revision was 42%. Eighty per cent of revisions were performed for chronic mechanical complication. Global results were considered to be good in 17 patients (35%), doubtful in 17 patients (35%) and a failure in 14 patients (30%), for the whole series. CONCLUSIONS The results of surgery for spinal deformities in patients with Parkinson disease vary with a high rate of complications and revisions. Nevertheless, these results should be seen in relation to the natural progression of these spinal deformities once spinal imbalance has developed. The association between preoperative clinical balance and final outcome suggests that early surgery can probably play a role in treatment. LEVEL OF EVIDENCE Level IV (e.g. case series).
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Purvis TE, Lubelski D, Mroz TE. Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson's Disease? Brain Sci 2017; 7:brainsci7040039. [PMID: 28394266 PMCID: PMC5406696 DOI: 10.3390/brainsci7040039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment.
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Affiliation(s)
- Taylor E Purvis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA.
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
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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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Malla HP, Kim MK, Kim TS, Jo DJ. Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease. J Korean Neurosurg Soc 2016; 59:655-658. [PMID: 27847583 PMCID: PMC5106369 DOI: 10.3340/jkns.2016.59.6.655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/07/2015] [Accepted: 10/05/2015] [Indexed: 11/27/2022] Open
Abstract
Parkinson's disease (PD) patients frequently have several spinal deformities leading to postural instabilities including camptocormia, myopathy-induced postural deformity, Pisa syndrome, and progressive degeneration, all of which adversely affect daily life activities. To improve these postural deformities and relieve the related neurologic symptoms, patients often undergo spinal instrumentation surgery. Due to progressive degenerative changes related to PD itself and other complicating factors, patients and surgeons are faced with instrument failure-related complications, which can ultimately result in multiple revision surgeries yielding various postoperative complications and morbidities. Here, we report a representative case of a 70-year-old PD patient with flat back syndrome who had undergone several revision surgeries, including anterior and posterior decompression and fusion for a lumbosacral spinal deformity. The patient ultimately benefitted from a relatively short segment fixation and corrective fusion surgery.
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Affiliation(s)
| | - Min Ki Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Sung Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Xiao R, Miller JA, Lubelski D, Alberts JL, Mroz TE, Benzel EC, Krishnaney AA, Machado AG. Quality of life outcomes following cervical decompression for coexisting Parkinson's disease and cervical spondylotic myelopathy. Spine J 2016; 16:1358-1366. [PMID: 27496286 DOI: 10.1016/j.spinee.2016.07.530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM. PURPOSE The purpose of the present study was to characterize QOL outcomes for patients with coexisting PD and CSM following cervical decompression. STUDY DESIGN/SETTING This is a matched cohort study at a single tertiary-care center. PATIENT SAMPLE Patients with coexisting PD and CSM undergoing cervical decompression between June 2009 and December 2014 were included. These patients were matched to controls with CSM alone by age, gender, American Society of Anesthesiologists classification, Modified Japanese Orthopaedic Association scores, and operative parameters. OUTCOME MEASURES The primary outcome measure was QOL outcomes assessed by change in the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9) at last follow-up (LFU). Change in QOL exceeding the minimal clinically important difference (MCID) was secondary. METHODS QOL data were collected using the institutional prospectively collected database of patient-reported health status measures. Simple and multivariable regressions were used to assess the impact of PD upon change in QOL. RESULTS Eleven PD patients were matched to 44 controls. Control patients experienced QOL improvement across all three measures, whereas PD patients only improved with respect to PDQ(89.9-80.7, p=.03). Despite no significant differences in preoperative QOL, PD patients experienced poorer QOL at LFU in EQ-5D (0.526 vs. 0.707, p=.01) and PDQ (80.7 vs. 51.4, p=.03), and less frequently achieved an EQ-5D MCID (18% vs. 57%, p=.04). However, no differences in the achievement of an MCID in PDQ or PHQ-9 were observed between cohorts. Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D (β=-0.09, p<.01) and failure to achieve an EQ-5D MCID (odds ratio: 0.08, p<.01). CONCLUSIONS This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D.
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Affiliation(s)
- Roy Xiao
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Jacob A Miller
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University, 855 N Wolfe St, Baltimore, MD 21205, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Ajit A Krishnaney
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Andre G Machado
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Puvanesarajah V, Jain A, Qureshi R, Carstensen SE, Tyger R, Hassanzadeh H. Elective Thoracolumbar Spine Fusion Surgery in Patients with Parkinson Disease. World Neurosurg 2016; 96:267-271. [PMID: 27647037 DOI: 10.1016/j.wneu.2016.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates. METHODS The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P < 0.001. RESULTS Major medical complications were observed in 545 patients (11.3%) for 90 days after the index procedure. Postoperative infection was noted in 91 patients (1.9%) within 90 days, and revision surgeries were performed in 250 patients (5.2%) within 1 year. Multivariate analysis showed that Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P < 0.001) and revision surgery (adjusted odds ratio, 1.70; 95% confidence interval, 1.49-1.93; P < 0.001), but not postoperative infection (P = 0.02). CONCLUSIONS Patients with Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes.
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Affiliation(s)
- Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rabia Qureshi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - S Evan Carstensen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Rosemarie Tyger
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Abstract
A wide range of neuromuscular diseases, including Parkinson disease, cerebral palsy, multiple sclerosis, and myopathy, are associated with spinal deformities. The most common postural deformities include anterocollis, Pisa syndrome (pleurothotonus), scoliosis, and camptocormia. Nonsurgical management of spinal deformity in patients with neuromuscular disease centers on maximizing the medical management of the underlying neurodegenerative pathology before surgical intervention is contemplated. Surgical management can include decompression alone, or decompression and fusion with short or long fusion constructs. Patients with neuromuscular disease are susceptible to postoperative medical complications, such as delirium, epidural hematomas, pulmonary emboli, and cardiac events. Compared with outcomes in the typical patient with spinal deformity, postoperative outcomes in patients with neuromuscular disease have higher rates of surgical complications, such as instrumentation failure, proximal junctional kyphosis, loss of correction, and the need for revision surgery, regardless of the magnitude of surgical treatment.
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Margraf N, Wrede A, Deuschl G, Schulz-Schaeffer W. Pathophysiological Concepts and Treatment of Camptocormia. JOURNAL OF PARKINSON'S DISEASE 2016; 6:485-501. [PMID: 27314757 PMCID: PMC5008234 DOI: 10.3233/jpd-160836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 12/12/2022]
Abstract
Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk. The clinical definition using only the bending angle is insufficient; it should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs (e.g. back-swept wing sign). Due to the heterogeneous etiologies of camptocormia a broad diagnostic approach is necessary. Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)). The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy. PD and probably myositic camptocormia can be divided into an acute and a chronic stage according to the duration of camptocormia and the findings in the short time inversion recovery (STIR) and T1 sequences of paravertebral muscle MRI. There is no established treatment of camptocormia resulting from any etiology. Case series suggest that deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is effective in the acute but not the chronic stage of PD camptocormia. In chronic stages with degenerated muscles, treatment options are limited to orthoses, walking aids, physiotherapy and pain therapy. In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended. In dystonic camptocormia, as in dystonia in general, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective. Camptocormia in connection with primary myopathies should be treated according to the underlying illness.
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Affiliation(s)
- N.G. Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A. Wrede
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - G. Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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Low Back Pain Caused by Superior Cluneal Nerve Entrapment Neuropathy in Patients with Parkinson Disease. World Neurosurg 2016; 87:250-4. [DOI: 10.1016/j.wneu.2015.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
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Glassman SD, Coseo MP, Carreon LY. Sagittal balance is more than just alignment: why PJK remains an unresolved problem. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:1. [PMID: 27252982 PMCID: PMC4888517 DOI: 10.1186/s13013-016-0064-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The durability of adult spinal deformity surgery remains problematic. Revision rates above 20 % have been reported, with a range of causes including wound infection, nonunion and adjacent level pathology. While some of these complications have been amenable to changes in patient selection or surgical technique, Proximal Junctional Kyphosis (PJK) remains an unresolved challenge. This study examines the contributions of non-mechanical factors to the incidence of postoperative sagittal imbalance and PJK after adult deformity surgery. METHODS We reviewed a consecutive series of adult spinal deformity patients who required revision for PJK from 2013 to 2015 and examined in their medical records in detail. RESULTS Neurologic disorders were identified in 22 (76 %) of the 29 PJK cases reviewed in this series. Neurologic disorders included Parkinson's disease (1), prior stroke (5), metabolic encephalopathy (2), seizure disorder (1), cervical myelopathy (7), thoracic myelopathy (1), diabetic neuropathy (5) and other neuropathy (4). Other potential comorbidities affecting standing balance included untreated cataracts (9), glaucoma (1) and polymyositis (1). Eight patients were documented to have frequent falls, with twelve cases having a fall right before symptoms related to the PJK were noted. CONCLUSION PJK is an important contributing factor to the substantial and unsustainable rate of revision surgery following adult deformity correction. Multiple efforts to avoid PJK via alterations in surgical technique have been largely unsuccessful. This study suggests that non-mechanical neuromuscular co-morbidities play an important role in post-operative sagittal imbalance and PJK. Recognizing the multi-factorial etiology of PJK may lead to more successful strategies to avoid PJK and improve surgical outcomes.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
| | - Mark P Coseo
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
| | - Leah Y Carreon
- Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, Kentucky 40202 USA
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Srivanitchapoom P, Hallett M. Camptocormia in Parkinson's disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry 2016; 87:75-85. [PMID: 25896683 PMCID: PMC5582594 DOI: 10.1136/jnnp-2014-310049] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/30/2015] [Indexed: 12/22/2022]
Abstract
Camptocormia is an axial postural deformity characterised by abnormal thoracolumbar spinal flexion. The symptom usually presents while standing, walking or exercising and is alleviated while sitting, lying in a recumbent position, standing against a wall or using walking support. There is no consensus on the degree of thoracolumbar flexion to define camptocormia. However, most authors usually use an arbitrary number of at least 45° flexion of the thoracolumbar spine when the individual is standing or walking. Aetiologies of camptocormia are heterogeneous, and Parkinson's disease (PD) is one of its many causes. The prevalence of camptocormia in PD ranges from 3% to 18%. Central and peripheral mechanisms might both contribute to its pathogenesis. Although there is no established consensus for treatment of camptocormia in PD, there are non-pharmacological, pharmacological and surgical approaches that can be used.
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Affiliation(s)
- Prachaya Srivanitchapoom
- Faculty of Medicine, Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Association Between Sagittal Balance and Scoliosis in Patients with Parkinson Disease. Am J Phys Med Rehabil 2016; 95:39-46. [PMID: 26062043 DOI: 10.1097/phm.0000000000000328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Moon BJ, Smith JS, Ames CP, Shaffrey CI, Lafage V, Schwab F, Matsumoto M, Baik JS, Ha Y. Prevalence and type of cervical deformities among adults with Parkinson's disease: a cross-sectional study. J Neurosurg Spine 2015; 24:527-34. [PMID: 26654338 DOI: 10.3171/2015.6.spine141197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT To identify the characteristics of cervical deformities in Parkinson's disease (PD) and the role of severity of PD in the development of cervical spine deformities, the authors investigated the prevalence of the cervical deformities, cervical kyphosis (CK), and cervical positive sagittal malalignment (CPSM) in patients with PD. They also analyzed the association of severity of cervical deformities with the stage of PD in the context of global sagittal spinopelvic alignment. METHODS This study was a prospective assessment of consecutively treated patients (n = 89) with PD. A control group of the age- and sex-matched patients was selected from patients with degenerative cervical spine disease but without PD. Clinical and demographic parameters including age, sex, duration of PD, and Hoehn and Yahr (H&Y) stage were collected. Full-length standing radiographs were used to assess spinopelvic parameters. CK was defined as a C2-7 Cobb angle < 0°. CPSM was defined as C2-7 sagittal vertical axis (SVA) > 4 cm. RESULTS A significantly higher prevalence of CPSM (28% vs. 1.1%, p < 0.001), but not CK (12% vs. 10.1%, p = 0.635), was found in PD patients compared with control patients. Among patients with PD, those with CK were younger (62.1 vs. 69.0 years, p = 0.013) and had longer duration of PD (56.4 vs. 36.2 months, p = 0.034), but the severity of PD was not significantly different. Logistic regression analysis revealed that the presence of CK was associated with younger age, higher mismatch between pelvic incidence and lumbar lordosis, and lower C7-S1 SVA. The patients with CPSM had significantly greater thoracic kyphosis (TK) (p < 0.001) and a trend toward more advanced H&Y stage (p = 0.05). Logistic regression analysis revealed that CPSM was associated with male sex, greater TK, and more advanced H&Y stage. CONCLUSIONS Patients with PD have a significantly higher prevalence of CPSM compared with age- and sex-matched control patients with cervical degenerative disease but without PD. Among patients with PD, CK is not associated with the severity of PD but is associated with overall global sagittal malalignment. In contrast, the presence of CPSM is associated more with the severity of PD than it is with the presence of global sagittal malalignment. Collectively, these data suggest that the neuromuscular pathogenesis of PD may affect the development of CPSM more than of CK.
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Affiliation(s)
- Bong Ju Moon
- Department of Medicine, Graduate School of Yonsei University, Seoul, Korea
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurosurgery, University of California, San Francisco, California
| | - Christopher I Shaffrey
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan and
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine and
| | - Yoon Ha
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
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Huang LC, Chung WF, Liu SW, Chang PY, Chen LF, Wu JC, Chen YC, Huang WC, Liu L, Cheng H, Lo SS. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12618-27. [PMID: 26473897 PMCID: PMC4626989 DOI: 10.3390/ijerph121012618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
Abstract
Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD), a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD) in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439) who received spinal fusion surgery, and the control group (n = 2124) who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years) was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001). Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model). Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke in adult patients with spinal deformity.
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Affiliation(s)
- Liang-Chung Huang
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Wu-Fu Chung
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Shih-Wei Liu
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
| | - Peng-Yuan Chang
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan.
| | - Li-Fu Chen
- Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Jau-Ching Wu
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan.
| | - Yu-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan.
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 260, Taiwan.
| | - Wen-Cheng Huang
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan.
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Henrich Cheng
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan.
- Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan.
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
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Chieng LO, Madhavan K, Wang MY. Deep brain stimulation as a treatment for Parkinson’s disease related camptocormia. J Clin Neurosci 2015; 22:1555-61. [DOI: 10.1016/j.jocn.2015.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/17/2015] [Indexed: 12/11/2022]
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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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Margraf NG, Rohr A, Granert O, Hampel J, Drews A, Deuschl G. MRI of lumbar trunk muscles in patients with Parkinson’s disease and camptocormia. J Neurol 2015; 262:1655-64. [DOI: 10.1007/s00415-015-7726-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, Oehlwein C. Effect of neurostimulation on camptocormia in Parkinson's disease depends on symptom duration. Mov Disord 2015; 30:368-72. [PMID: 25678310 PMCID: PMC5132064 DOI: 10.1002/mds.26081] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 10/06/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
Although some reports on neurostimulation are positive, no effective treatment method for camptocormia in Parkinson's disease (PD) is known to date. We aim to identify prognostic factors for a beneficial DBS effect on camptocormia. In an observational cohort study, we investigated 25 idiopathic PD patients, who suffered additionally from camptocormia, and underwent bilateral neurostimulation of the subthalamic nucleus (STN) to improve classical PD symptoms. Using an established questionnaire, we examined deep brain stimulation (DBS) effects on camptocormia in addition to general neurostimulation effects. A beneficial neurostimulation effect on camptocormia was defined as an improvement in the bending angle of a least 50%. In 13 patients, the bending angle of camptocormia improved, in 12 patients it did not. A multifactorial analysis revealed a short duration between onset of camptocormia and start of neurostimulation to be the relevant factor for outcome. All patients with duration of camptocormia up to 1.5 years showed a beneficial effect; patients between 1.5 and ∼3 years showed mixed results, but none with a duration of more than 40 months improved except for 1 patient whose camptocormia was levodopa responsive. The bending angle was not a prognostic factor. Our data indicate that the main prognostic factor for a beneficial DBS effect on camptocormia is its short duration. As an explanation, we suggest that neurostimulation may improve camptocormia only as long as muscle pathology is limited. Our findings may help to elucidate the mode of action of neurostimulation. A prospective study is necessary. © 2015 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Walter J Schulz-Schaeffer
- Prion and Dementia Research Unit, Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
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Choi HJ, Smith JS, Shaffrey CI, Lafage VC, Schwab FJ, Ames CP, Matsumoto M, Baik JS, Ha Y. Coronal plane spinal malalignment and Parkinson's disease: prevalence and associations with disease severity. Spine J 2015; 15:115-21. [PMID: 25041726 DOI: 10.1016/j.spinee.2014.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/23/2014] [Accepted: 07/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing. PURPOSE To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity. STUDY DESIGN A cross-sectional study. PATIENT SAMPLE Eighty-nine patients with PD and 89 controls were included. OUTCOME MEASURES A medical history was collected from the medical records. METHODS This study was a prospective assessment of consecutive patients with PD. Clinical and demographic parameters were collected from medical records and outpatient interviews. Full-length standing anteroposterior and lateral spine radiographs were used to assess the spinal parameters. The threshold for scoliosis was set at a 10° Cobb angle, and the curve type was classified using Schwab classification. RESULTS A total of 178 patients (89 in PD and 89 in control groups) were included. Scoliosis was identified in 27 patients (30%) and 22 controls (p=.502). However, coronal imbalance was more common in patients with PD than in controls (11 vs. 0 patients, p=.001). Scoliosis was more common in women than in men (male:female=8:19, p=.04). Back pain was more common in patients with scoliosis than in those without scoliosis (14 of 27 vs. 17 of 62, p=.036). Schwab Type IV (thoracolumbar major) was the most common type of scoliosis in patients with PD and Type V (lumbar major) was the most common type in controls. With adjustment for patient age and gender, multiple linear regression analysis revealed that severity of PD (Unified Parkinson's Disease Rating Scale, p=.037) and magnitude of global coronal malalignment (p=.003) were associated with the scoliosis Cobb angle (p=.037, B=0.139). Direction of scoliosis and side of global coronal malalignment were not significantly correlated with the laterality of predominant PD symptoms (p>.05). CONCLUSIONS Global coronal malalignment is more prevalent in patients with PD than in controls. Greater severity of PD was significantly associated with greater magnitude of scoliosis Cobb angle, even after adjusting for the effects of patient age and gender. However, direction of scoliosis and side of global coronal malalignment were not significantly associated with the dominant laterality of PD symptoms.
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Affiliation(s)
- Hong June Choi
- Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA
| | - Virginie C Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA
| | - Christopher P Ames
- Department of Neurosurgery, University of California San Francisco, 220 Montgomery St., San Francisco, CA 94104, USA
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku, Tokyo, Japan
| | - Jong Sam Baik
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, Korea
| | - Yoon Ha
- Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea.
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Sapkas G, Lykomitros V, Soultanis K, Papadopoulos EC, Papadakis M. Spinal surgery in patients with Parkinson's disease: unsatisfactory results, failure and disappointment. Open Orthop J 2014; 8:264-7. [PMID: 25246991 PMCID: PMC4157348 DOI: 10.2174/1874325001408010264] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 06/28/2014] [Accepted: 07/04/2014] [Indexed: 12/02/2022] Open
Abstract
Previous studies on spinal surgery in PD patients report an exceptionally high rate of complications. Failure and re -operation are frequent outcomes. This is a retrospective case series with the aim of establishing the rate of complications in patients with concomitant Parkinson’s disease. Ten patients were subjected to spinal surgery from 2005 to 2009. The indications and type of operation varied. Cases of Failed Back Surgery and re-operation were sought. Follow – up was between 6 – 42 months. All 10 patients presented some clinical or radiological complication. The most common complications were screw pull – out and progressive spinal deformity. Re – operations were performed in 5 patients, while clinical and radiological results were poor in the majority of cases. Patients with Parkinson’s disease have a very high complication rate and often have to undergo revision surgery. This particular group of patients should be informed of the increased risk of failure and be closely followed – up on a regular basis.
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Affiliation(s)
- G Sapkas
- Department of Orthopaedics, Faculty of Medicine, University of Athens, Greece
| | - V Lykomitros
- Department of Orthopaedics, Faculty of Medicine, University of Thessaloniki, Greece
| | - K Soultanis
- Department of Orthopaedics, Faculty of Medicine, University of Athens, Greece
| | - E C Papadopoulos
- Department of Orthopaedics, Faculty of Medicine, University of Thessaloniki, Greece
| | - M Papadakis
- Department of Orthopaedics, Faculty of Medicine, University of Thessaloniki, Greece
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Sutter P, Forster T, Külling F. [Spinal deformity in Parkinson's disease: a treatment proposal]. Unfallchirurg 2014; 116:955-9. [PMID: 23052707 DOI: 10.1007/s00113-012-2271-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spinal deformities in Parkinson's disease are difficult to treat but with good indications, spinal surgery is a better treatment option taking into account all factors that accompany Parkinson's disease. Despite greater operational time and cost expenditure with a long rehabilitation period, long stretch segmental fusion is preferable to short stretch segment fusion due to the lower revision rate. An adequate postoperative rehabilitation and good patient care is essential for success. This case illustrates successful treatment of a patient with Parkinson's disease and camptocormia by long stretch segmental fusion.
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Affiliation(s)
- P Sutter
- Klinik für Orthopädische Chirurgie und Traumatologie, Kantonsspital St. Gallen, Rorschacherstraße 7, CH-9007, St. Gallen, Schweiz,
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Spinopelvic balance: new biomechanical insights with clinical implications for 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 2013; 23:576-83. [PMID: 24162521 DOI: 10.1007/s00586-013-3068-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 09/26/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to describe the disease-related sagittal balance changes in relation to the sacropelvic morphology of PD patients with different durations of disease. METHODS Thirty-one consecutive Parkinson's disease patients (26 males, 5 females; age 55-83 years) participated in the cross-sectional study. The clinical assessment included: Hoehn Yahr score; plumb line distance from the spinous process of C7, kyphosis apex, spinous process of L3 and S1. Lumbar lordosis (LL), thoracic kyphosis (TK), spinosacral angle, spinopelvic angle, spinal tilt, pelvic incidence, sacral slope (SS) and pelvic tilt were radiographically assessed. RESULTS Radiographic spinopelvic angles appeared normal, but many patients presented variations from normality. In particular, pelvic tilt increased and SS decreased; spinosacral and spinopelvic angles were greatly reduced compared to healthy people, and spinal tilt increased. Unlike TK, LL was well correlated with most of the parameters. CONCLUSIONS Sagittal balance evaluation provides new valuable insights for biomechanical understanding of PD patients. Specific spinal parameters (spinosacral, spinopelvic and spinal tilt angles), and their clinical correlation, as well as pelvic parameters like pelvic tilt and sacral slope, appear particularly interesting for their clinical implications in terms of spinal deformities correction in PD population.
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Shih LC, Vanderhorst VG, Lozano AM, Hamani C, Moro E. Improvement of pisa syndrome with contralateral pedunculopontine stimulation. Mov Disord 2013; 28:555-6. [PMID: 23389993 DOI: 10.1002/mds.25301] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/24/2012] [Indexed: 12/24/2022] Open
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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. ACTA ACUST UNITED AC 2012; 25:E53-60. [PMID: 22460399 DOI: 10.1097/bsd.0b013e3182496670] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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