J Korean Neurosurg Soc.  2016 Nov;59(6):655-658. 10.3340/jkns.2016.59.6.655.

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

• Malla HP
• Kim MK
• Kim TS
• Jo DJ

• KMID: 2417352
• DOI: http://doi.org/10.3340/jkns.2016.59.6.655

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.

Keyword

Parkinson's disease; Flat back syndrome; Deformity; Complication

MeSH Terms

Aged
Congenital Abnormalities
Decompression
Humans
Neurologic Manifestations
Parkinson Disease*
Postoperative Complications
Surgeons

Figure

• 

  Fig. 1 Anteroposterior (A) and lateral (B) whole spine X-rays with respective pelvic parameters and clinical photograph (C) showing marked coronal and sagittal imbalance along with compensatory thoracic straightening and cervical hyperextension to maintain vertical gaze. *Indicates the lumbar lordosis. PI : pelvic incidence, LL : lumbar lordosis, SVA : sagittal vertical axis.

• 

  Fig. 2 Lateral thoracolumbar X-ray (A) showing PPSO & discectomy (Grade IV osteotomy) performed at the L4 and L3–4 level, respectively, and lateral thoracolumbar X-ray (B) showing the correction angle of approximately 30 degrees at the same level postoperatively. PPSO : partial pedicle subtraction osteotomy.

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  Fig. 3 Follow-up anteroposterior (A) and lateral (B) whole spine X-rays showing satisfactory correction of coronal and sagittal imbalance. *Indicates the lumbar lordosis, **Indicates sagittal vertical axis. PI : pelvic incidence, LL : lumbar lordosis, SVA : sagittal vertical axis.

Reference

1. Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord. 2006; 21:1856–1863. PMID: 16941460.

2. Babat LB, McLain RF, Bingaman W, Kalfas I, Young P, Rufo-Smith C. Spinal surgery in patients with Parkinson's disease : construct failure and progressive deformity. Spine (Phila Pa 1976). 2004; 29:2006–2012. PMID: 15371701.

3. Bourghli A, Guérin P, Vital JM, Aurouer N, Luc S, Gille O, et al. 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. J Spinal Disord Tech. 2012; 25:E53–E60. PMID: 22460399.

4. Bridwell KH, Lenke LG, Lewis SJ. Treatment of spinal stenosis and fixed sagittal imbalance. Clin Orthop Relat Res. 2001; 384:35–44.

5. Christodoulou E, Chinthakunta S, Reddy D, Khalil S, Apostolou T, Drees P, et al. Axial pullout strength comparison of different screw designs : fenestrated screw, dual outer diameter screw and standard pedicle screw. Scoliosis. 2015; 10:15. PMID: 25949274.

6. Goost H, Deborre C, Wirtz DC, Burger C, Prescher A, Fölsch C, et al. PMMA-augmentation of incompletely cannulated pedicle screws : a cadaver study to determine the benefits in the osteoporotic spine. Technol Health Care. 2014; 22:607–615. PMID: 24837053.

7. Jankovic J. Parkinson's disease : clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008; 79:368–376. PMID: 18344392.

8. Koller H, Acosta F, Zenner J, Ferraris L, Hitzl W, Meier O, et al. Spinal surgery in patients with Parkinson's disease : experiences with the challenges posed by sagittal imbalance and the Parkinson's spine. Eur Spine J. 2010; 19:1785–1794. PMID: 20422434.

9. Moon SH, Lee HM, Chun HJ, Kang KT, Kim HS, Park JO, et al. Surgical outcome of lumbar fusion surgery in patients with Parkinson disease. J Spinal Disord Tech. 2012; 25:351–355. PMID: 21685805.

10. Paré PE, Chappuis JL, Rampersaud R, Agarwala AO, Perra JH, Erkan S, et al. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines. Spine (Phila Pa 1976). 2011; 36:E1210–E1214. PMID: 21325986.

11. Peek AC, Quinn N, Casey AT, Etherington G. Thoracolumbar spinal fixation for camptocormia in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2009; 80:1275–1278. PMID: 19864661.

12. Sato M, Sainoh T, Orita S, Yamauchi K, Aoki Y, Ishikawa T, et al. Posterior and anterior spinal fusion for the management of deformities in patients with Parkinson's disease. Case Rep Orthop. 2013; 2013:140916. PMID: 24073349.

13. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2014; 74:112–120. PMID: 24356197.

14. Tiple D, Fabbrini G, Colosimo C, Ottaviani D, Camerota F, Defazio G, et al. Camptocormia in Parkinson disease : an epidemiological and clinical study. J Neurol Neurosurg Psychiatry. 2009; 80:145–148. PMID: 18931011.

15. Upadhyaya CD, Starr PA, Mummaneni PV. Spinal deformity and Parkinson disease : a treatment algorithm. Neurosurg Focus. 2010; 28:E5.

16. Wadia PM, Tan G, Munhoz RP, Fox SH, Lewis SJ, Lang AE. Surgical correction of kyphosis in patients with camptocormia due to Parkinson's disease : a retrospective evaluation. J Neurol Neurosurg Psychiatry. 2011; 82:364–368. PMID: 20667867.

17. Yilmaz G, Hwang S, Oto M, Kruse R, Rogers KJ, Bober MB, et al. Surgical treatment of scoliosis in osteogenesis imperfecta with cement-augmented pedicle screw instrumentation. J Spinal Disord Tech. 2014; 27:174–180. PMID: 24945295.