Postural disorders in Parkinson’s disease

Bénatru, Isabelle; Vaugoyeau, Marianne; Azulay, J.-P.

doi:10.1016/j.neucli.2008.07.006

Cited by 146 publications

(141 citation statements)

References 50 publications

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“…3) as well as marked lateral trunk shift, also referred to as 'Pisa syndrome' (Fig. 1) [4]. Camptocormia is an abnormal posture with marked flexion of the thoracolumbar spine, and it increases with time and fatigue during the day and during walking; it is a progressive postural insufficiency that abates in recumbent position, sitting or volitionally when the PD patient leans against a wall.…”

Section: Discussionmentioning

confidence: 99%

“…Postural instability, which increases with duration and severity of the disease including gait disorders, balance impairments with subsequent falls and fall-related injuries affects the quality of life negatively [4,7]. The cardinal features of PD are rest tremor, rigidity and bradykinesia; disease-specific features include stooped posture, slow movements, trunk imbalance with shuffling gait, and expressionless facies [4]. To spine surgeons, PD usually presents as a neuromuscular disorder in elderly patients displaying slight to severe postural impairment posed on a significant spinal deformity or degenerative instability with stenosis [4].…”

Section: Introductionmentioning

confidence: 99%

“…The cardinal features of PD are rest tremor, rigidity and bradykinesia; disease-specific features include stooped posture, slow movements, trunk imbalance with shuffling gait, and expressionless facies [4]. To spine surgeons, PD usually presents as a neuromuscular disorder in elderly patients displaying slight to severe postural impairment posed on a significant spinal deformity or degenerative instability with stenosis [4]. Inadequate data concerning spinal surgery in patients with PD exist, which report of high complication rates, including multiple reoperations in 86% and construct failure in 29% of patients [2].…”

Section: Introductionmentioning

confidence: 99%

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Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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Only a few reports exist concerning biomechanical challenges spine surgeons face when treating Parkinson's disease (PD) patients with spinal deformity. We recognized patients suffering from spinal deformity aggravated by the burden of PD to stress the principles of sagittal balance in surgical treatment. Treatment of sagittal imbalance in PD is difficult due to brittle bone and (the neuromuscular disorder) with postural dysfunction. We performed a retrospective review of 23 PD patients treated surgically for spinal disorders. Mean ASA score was 2.3 (2-3). Outcome analysis included review of medical records focusing on failure characteristics, complications, and radiographic analysis of balance parameters to characterize special risk factors or precautions to be considered in PD patients. The sample included 15 female and 8 male PD patients with mean age of 66.3 years (57-76) at index surgery and 67.9 years (59-76) at follow-up. 10 patients (43.5%) presented with the sequels of failed previous surgery. 18 patients (78.3%) underwent multilevel fusion (C3 level) with 16 patients (69.6%) having fusion to S1, S2 or the Ilium. At a mean follow-up of 14.5 months (1-59) we noted medical complications in 7 patients (30.4%) and surgical complications in 12 patients (52.2%). C7-sagittal center vertical line was 12.2 cm (8-57) preoperatively, 6.9 cm postoperatively, and 7.6 cm at follow-up. Detailed analysis of radiographs, sagittal spinal, and spino-pelvic balance, stressed a positive C7 off-set of 10 cm on average in 25% of patients at follow-up requiring revision surgery in 4 of them. Statistical analysis revealed that patients with a postoperative or follow-up sagittal imbalance (C7-SVL [10 cm) had a significantly increased rate of revision done or scheduled (p = 0.03). Patients with revision surgery as index procedure also were found more likely to suffer postoperative or final sagittal imbalance (C7-SPL, 10 cm; p = 0.008). At all, 33% of patients had any early or late revision performed. Nevertheless, 78% of patients were satisfied or very satisfied with their clinical outcome, while 22% were either not satisfied or uncertain regarding their outcome. The surgical history of PD patients treated for spinal disorders and the reasons necessitating redo surgery for recalcitrant global sagittal imbalance in our sample stressed the mainstays of spinal surgery in Parkinson's: If spinal surgery is indicated, the reconstruction of spinopelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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“…As alterações posturais presentes em indivíduos com DP podem ser decorrentes de dois componentes: de equilíbrio e de orientação postural 5 . O componente de equilíbrio refere-se à perda de reflexos posturais, enquanto que o componente postural de orientação é representado pelas posturas 5 : Flexora, Camptocormia (flexão da coluna toracolombar de aproximadamente 45º) 6 , Síndrome de Pisa (lateroflexão do tronco de 10 a 15º graus aproximadamente, que desaparece quando o paciente deita em supino) [5][6][7] , Antecollis (flexão do pescoço com deslocamento anterior da cabeça) 8 e escoliose9.…”

Section: Resumo | Introdução: Indivíduos Com Doença Deunclassified

“…O componente de equilíbrio refere-se à perda de reflexos posturais, enquanto que o componente postural de orientação é representado pelas posturas 5 : Flexora, Camptocormia (flexão da coluna toracolombar de aproximadamente 45º) 6 , Síndrome de Pisa (lateroflexão do tronco de 10 a 15º graus aproximadamente, que desaparece quando o paciente deita em supino) [5][6][7] , Antecollis (flexão do pescoço com deslocamento anterior da cabeça) 8 e escoliose9. Dentre as deformidades posturais citadas, a postura típica do Parkinson é a postura flexora: flexão de joelhos e tronco, com cotovelos flexionados e braços aduzidos 5,9 .…”

Section: Resumo | Introdução: Indivíduos Com Doença Deunclassified