European Spine Journal

, Volume 19, Issue 10, pp 1785–1794

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

  • Heiko Koller
  • Frank Acosta
  • Juliane Zenner
  • Luis Ferraris
  • Wolfgang Hitzl
  • Oliver Meier
  • Steven Ondra
  • Tyler Koski
  • Rene Schmidt
Original Article

DOI: 10.1007/s00586-010-1405-y

Cite this article as:
Koller, H., Acosta, F., Zenner, J. et al. Eur Spine J (2010) 19: 1785. doi:10.1007/s00586-010-1405-y

Abstract

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 spino-pelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

Keywords

Parkinson’s disease Spine surgery Adult spinal deformity Sagittal balance Failure Spino-pelvic 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Heiko Koller
    • 1
  • Frank Acosta
    • 2
  • Juliane Zenner
    • 1
  • Luis Ferraris
    • 1
  • Wolfgang Hitzl
    • 4
  • Oliver Meier
    • 1
  • Steven Ondra
    • 3
  • Tyler Koski
    • 3
  • Rene Schmidt
    • 1
  1. 1.German Scoliosis Center Bad WildungenWerner-Wicker-KlinikBad WildungenGermany
  2. 2.Cedars-Sinai Medical CenterLos AngelesUSA
  3. 3.Northwestern Memorial HospitalChicagoUSA
  4. 4.Research Office, BiostatisticsParacelsus Medical UniversitySalzburgAustria

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