Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease

Malla, Hridayesh Pratap; Kim, Min Ki; Kim, Tae Sung; Jo, Dae Jean

doi:10.3340/jkns.2016.59.6.655

Cited by 6 publications

(10 citation statements)

References 17 publications

(22 reference statements)

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“…A high rate of revision (31.9 ± 29.1%; range: 25.8–100%) following instrumentation of the the thoracolumbar spine is described in the literature. 8 9 10 11 12 13 In our retrospective case-control study, we found a comparatively high rate of revision (43.8%) for PD patients. Concerning indications of revision surgery, we found hardware failure (57.1%) to be the most frequent, a finding in accordance with former studies (47.4 ± 36.5%; range: 0–100%).…”

Section: Discussionmentioning

confidence: 59%

“…3 4 5 6 7 The management of osteoporosis in patients undergoing spine surgery is challenging—unsurprisingly, many authors found osteoporosis to be an unfavorable comorbidity in PD patients who underwent spine surgery. 2 8 12 15 16 17 Among our PD cohort, 62.5% had BMD < 100 HU, which we defined as osteoporosis: eight patients with osteoporotic fractures 18 (OF III n = 1, OF IV n = 7), one patient with a traumatic fracture 19 (A3), and two patients with degenerative spondylolisthesis (Meyerding I). Kawaguchi et al 10 reported the case of a 67-year old woman with osteoporotic fractures of L4 and L5 who developed a new fracture of L1 6 months after initial vertebral body replacement (VBR) and instrumentation from L1 to S1, resulting in an extension of the instrumentation to T4.…”

Section: Discussionmentioning

confidence: 99%

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Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study

Spindler

Tkatschenko

Alzoobi

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. Methods In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. Results We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). Conclusion PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study

Spindler

Tkatschenko

Alzoobi

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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“…static upright X-rays) are not effective for PD patients. Despite the detailed and, as described, difficult pre-OP diagnostics, the results of spinal surgery in PD patients are disappointing [4][5][6]. Yet in view of the increasing demand [1], there is an obvious gap of knowledge which must take considerations of further pre-operative aspects into account.…”

Section: Discussionmentioning

confidence: 99%

“…The stooped posture with flexing of the hips and knees as well as some degree of the trunk and neck is indeed one of the most noticeable signs of PD. As expected, the demand for spinal surgery in patients with PD increases rapidly, but the results are disappointing with failure rates of 25.8-100% [4][5][6][7]. It is already well understood that spinal deformity in PD is unique from degenerative deformity.…”

Section: Introductionmentioning

confidence: 85%

A noninvasive method to quantify the impairment of spinal motion ability in Parkinson’s disease

et al. 2022

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Purpose There is a high demand on spinal surgery in patients with Parkinson’s disease (PD) but the results are sobering. Although detailed clinical and radiological diagnostics were carried out with great effort and expense, the biodynamic properties of the spine of PD patients have never been considered. We propose a noninvasive method to quantify the impairment of motion abilities in patients with PD. Methods We present an analytical cross-sectional study of 21 patients with severe PD. All patients underwent a biodynamic assessment during a standardized movement-choreography. Thus, individual spinal motion profiles of each patient were objectively assessed and compared with a large comparative cohort of individuals without PD. Moreover, clinical scores to quantify motor function and lumbar back pain were collected and X-ray scans of the spine in standing position were taken and analysed. Results Biodynamic measurement showed that 36.9% of the assessed motions of all PD patients were severely impaired. Men were generally more functionally impaired than women, in 52% of all motion parameters. The neurological and radiological diagnostics recorded pathological values, of which UPDRS-III ON correlated with findings of the biodynamics assessment (R = 0.52, p = 0.02). Conclusions The decision to operate on a PD patient’s spine is far-reaching and requires careful consideration. Neurological and radiological scores did not correlate with the biodynamics of the spine. The resulting motion profile could be used as individual predictive factor to estimate whether patients are eligible for spinal surgery or alternative therapies.

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“…With the increasing prevalence of PD and the associated degenerative spinal conditions, the demand for spinal surgery in patients with PD increases rapidly. However, the results of spinal surgery for degenerative spinal conditions in patients with PD are disappointing with failure rates of 25.8-100% [8][9][10][11][12]. As an alternative treatment strategy for the underlying pathomechanism, some authors have described the influence of deep brain stimulation on PD-related postural abnormalities [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

et al. 2022

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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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Multiple Spinal Revision Surgery in a Patient with Parkinson's Disease

Cited by 6 publications

References 17 publications

Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study

Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study

A noninvasive method to quantify the impairment of spinal motion ability in Parkinson’s disease

Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

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