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The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery

European Spine Journal volume 27, pages 2847–2853 (2018)Cite this article

Abstract

Purpose

This observational study was aimed at quantification of low back pain (LBP) in Parkinsonian patients and its morphological correlation.

Background

Parkinson’s disease (PD) is a common disabling condition in the elderly population. Parkinsonian patients frequently are troubled by LBP. Causes for LBP in PD are muscular imbalances by the movement disorder itself and skeletal degeneration.

Methods

Ninety-seven PD patients and 97 controls were inquired about low back pain through the Oswestry Low Back Pain Disability Questionnaire and visual analogue scales. Fifty-four patients with LBP underwent X-ray of the lumbar spine in two planes and flexion–extension views. Parkinson’s disease was characterized by stage, disease duration, motor score, lateralization of symptoms and dosage of medication.

Results

LBP occurred significantly more frequent in PD (87.6%) compared to controls (62.6%) with longer duration and higher pain intensity. Pain intensity and disability scores were associated with higher PD stages and higher motor scores. Patients with the hypokinetic PD subtype experienced more pain intensity. X-ray of the lumbar spine revealed lumbar arthrosis in 79.6%, scoliosis in 38.8% and spondylolisthesis in 24.1% of PD patients with LBP. Lateralization of scoliosis and PD symptoms were significantly correlated. Only a small portion of PD patients with LBP received specialized orthopaedic treatment.

Conclusion

LBP and lumbar degeneration are common in PD. Both are related to movement disorder symptoms. The knowledge about musculoskeletal conditions in Parkinson’s disease is important for an interdisciplinary conservative or operative treatment decision of LBP.

Graphical abstract

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Abbreviations

DBS:

Deep brain stimulation

GPi:

Globus pallidus internus

H&Y:

Hoehn & Yahr stage

LBP:

Low back pain

LEDD:

Levodopa equivalent daily dosage

NMS:

Non-motor symptom

ODI:

Oswestry Low Back Pain Disability Questionnaire

PD:

Parkinson’s disease

RSA:

Other pain

RSB:

Burning

RSK:

Paraesthesia

RSS:

Generally pain

RSST:

Pricking

RST:

Tingling

SCS:

Spinal cord stimulation

STN:

Subthalamic nucleus

UPDRS III:

Unified Parkinson’s disease rating scale, part III

VAS:

Visual analogue scale

References

  1. Chaudhuri KR, Odin P, Antonini A, Martinez-Martin P (2011) Parkinson’s disease: the non-motor issues. Parkinsonism Relat Disord 17(10):717–723. https://doi.org/10.1016/j.parkreldis.2011.02.018

    Article  PubMed  Google Scholar 

  2. Politis M, Wu K, Molloy S, G Bain P, Chaudhuri KR, Piccini P (2010) Parkinson’s disease symptoms: the patient’s perspective. Mov Disord Off J Mov Disord Soc 25(11):1646–1651. https://doi.org/10.1002/mds.23135

    Article  Google Scholar 

  3. Ford B (1998) Pain in Parkinson’s disease. Clin Neurosci (New York, N.Y.) 5(2):63–72

    CAS  Google Scholar 

  4. Ashour R, Jankovic J (2006) Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord Off J Mov Disord Soc 21(11):1856–1863. https://doi.org/10.1002/mds.21058

    Article  Google Scholar 

  5. Kim YE, Lee W-W, Yun JY, Yang HJ, Kim H-J, Jeon BS (2013) Musculoskeletal problems in Parkinson’s disease: neglected issues. Parkinsonism Relat Disord 19(7):666–669. https://doi.org/10.1016/j.parkreldis.2013.03.002

    Article  PubMed  Google Scholar 

  6. Etchepare F, Rozenberg S, Mirault T, Bonnet A-M, Lecorre C, Agid Y, Bourgeois P, Fautrel B (2006) Back problems in Parkinson’s disease: an underestimated problem. Jt Bone Spine revue du rhumatisme 73(3):298–302. https://doi.org/10.1016/j.jbspin.2005.05.006

    Article  Google Scholar 

  7. Hallett M (2003) Parkinson revisited: pathophysiology of motor signs. Adv Neurol 91:19–28

    PubMed  Google Scholar 

  8. McCormack HM, Horne DJ, Sheather S (1988) Clinical applications of visual analogue scales: a critical review. Psychol Med 18(4):1007–1019

    CAS  Article  Google Scholar 

  9. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273

    CAS  PubMed  Google Scholar 

  10. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442

    CAS  Article  Google Scholar 

  11. Movement Disorder Society Task Force on Rating Scales for Parkinson's Disease (2003) The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations. Mov Disord Off J Mov Disord Soc 18(7):738–750. https://doi.org/10.1002/mds.10473

  12. Sandyk R (1982) Back pain as an early symptom of Parkinson’s disease. S Afr Med J Suid-Afrikaanse tydskrif vir geneeskunde 61(1):3

    CAS  PubMed  Google Scholar 

  13. Broetz D, Eichner M, Gasser T, Weller M, Steinbach JP (2007) Radicular and nonradicular back pain in Parkinson’s disease: a controlled study. Mov Disord Off J Mov Disord Soc 22(6):853–856. https://doi.org/10.1002/mds.21439

    Article  Google Scholar 

  14. Martin JP (1965) Curvature of the spine in post-encephalitic parkinsonism. J Neurol Neurosurg Psychiatry 28(5):395–400

    CAS  Article  Google Scholar 

  15. Herrera-Marschitz M, Utsumi H, Ungerstedt U (1990) Scoliosis in rats with experimentally-induced hemiparkinsonism: dependence upon striatal dopamine denervation. J Neurol Neurosurg Psychiatry 53(1):39–43

    CAS  Article  Google Scholar 

  16. Choi HJ, Smith JS, Shaffrey CI, Lafage VC, Schwab FJ, Ames CP, Matsumoto M, Baik JS, Ha Y (2015) Coronal plane spinal malalignment and Parkinson’s disease: prevalence and associations with disease severity. Spine J Off J N Am Spine Soc 15(1):115–121. https://doi.org/10.1016/j.spinee.2014.07.004

    Article  Google Scholar 

  17. Watanabe K, Hirano T, Katsumi K, Ohashi M, Ishikawa A, Koike R, Endo N, Nishizawa M, Shimohata T (2015) Characteristics and exacerbating factors of chronic low back pain in Parkinson’s disease. Int Orthop 39(12):2433–2438. https://doi.org/10.1007/s00264-015-3011-4

    Article  PubMed  Google Scholar 

  18. Moon S-H, Lee H-M, Chun H-J, Kang K-T, Kim H-S, Park J-O, Moon E-S, Chong H-S, Sohn J-S, Kim H-J (2012) Surgical outcome of lumbar fusion surgery in patients with Parkinson disease. J Spinal Disord Tech 25(7):351–355. https://doi.org/10.1097/BSD.0b013e318224a625

    Article  PubMed  Google Scholar 

  19. Babat LB, McLain RF, Bingaman W, Kalfas I, Young P, Rufo-Smith C (2004) Spinal surgery in patients with Parkinson’s disease: construct failure and progressive deformity. Spine 29(18):2006–2012

    Article  Google Scholar 

  20. Baker JF, McClelland S, Hart RA, Bess RS (2017) Management of spinal conditions in patients With Parkinson disease. J Am Acad Orthop Surg 25(8):e157–e165. https://doi.org/10.5435/JAAOS-D-16-00627

    Article  PubMed  Google Scholar 

  21. Baker JF, McClelland S, Line BG, Smith JS, Hart RA, Ames CP, Shaffrey C, Bess S (2017) In-hospital complications and resource utilization following lumbar spine surgery in patients with Parkinson disease. Evaluation of the National Inpatient Sample Database. World Neurosurg 106:470–476. https://doi.org/10.1016/j.wneu.2017.07.006

    Article  PubMed  Google Scholar 

  22. Schroeder JE, Hughes A, Sama A, Weinstein J, Kaplan L, Cammisa FP, Girardi FP (2015) Lumbar spine surgery in patients with Parkinson disease. J Bone Jt Surg 97(20):1661–1666. https://doi.org/10.2106/JBJS.N.01049

    Article  Google Scholar 

  23. Rommel O, Wejwer D, Schybek K, Przybilski T, Jäger G, Gräber S, Berg D (2016) Lendenwirbelsäulenschmerzen bei Patienten mit Morbus Parkinson (Lumbar back pain in patients with Parkinson’s disease). Der Nervenarzt 87(4):418–425. https://doi.org/10.1007/s00115-015-0060-2

    CAS  Article  PubMed  Google Scholar 

  24. Yamada K, Shinojima N, Hamasaki T, Kuratsu J-I (2016) Subthalamic nucleus stimulation improves Parkinson’s disease-associated camptocormia in parallel to its preoperative levodopa responsiveness. J Neurol Neurosurg Psychiatry 87(7):703–709. https://doi.org/10.1136/jnnp-2015-310926

    Article  PubMed  Google Scholar 

  25. Schulz-Schaeffer WJ, Margraf NG, Munser S, Wrede A, Buhmann C, Deuschl G, Oehlwein C (2015) Effect of neurostimulation on camptocormia in Parkinson’s disease depends on symptom duration. Mov Disord Off J Mov Disord Soc 30(3):368–372. https://doi.org/10.1002/mds.26081

    Article  Google Scholar 

  26. Srivanitchapoom P, Hallett M (2016) Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry 87(1):75–85. https://doi.org/10.1136/jnnp-2014-310049

    Article  PubMed  Google Scholar 

  27. Margraf NG, Wrede A, Deuschl G, Schulz-Schaeffer WJ (2016) Pathophysiological concepts and treatment of camptocormia. J Parkinson’s Disease 6(3):485–501. https://doi.org/10.3233/JPD-160836

    CAS  Article  Google Scholar 

  28. Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schäfer H, Bötzel K, Daniels C, Deutschländer A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider G-H, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J (2006) A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355(9):896–908. https://doi.org/10.1056/NEJMoa060281

    CAS  Article  PubMed  Google Scholar 

  29. Jung YJ, Kim H-J, Jeon BS, Park H, Lee W-W, Paek SH (2015) An 8-year follow-up on the effect of subthalamic nucleus deep brain stimulation on pain in Parkinson disease. JAMA Neurol 72(5):504–510. https://doi.org/10.1001/jamaneurol.2015.8

    Article  PubMed  Google Scholar 

  30. Upadhyaya CD, Starr PA, Mummaneni PV (2010) Spinal deformity and Parkinson disease: a treatment algorithm. Neurosurg Focus 28(3):E5. https://doi.org/10.3171/2010.1.FOCUS09288

    Article  PubMed  Google Scholar 

  31. Nishioka K, Nakajima M (2015) Beneficial therapeutic effects of spinal cord stimulation in advanced cases of Parkinson’s disease with intractable chronic pain: a case series. Neuromodulation J Int Neuromodulation Soc 18(8):751–753. https://doi.org/10.1111/ner.12315

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany

    Imke Galazky, Christina Caspari & Hans-Jochen Heinze

  2. German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany

    Hans-Jochen Heinze

  3. Department of Behavioural Neurology, Leibniz Institute of Neurobiology, Brenneckestr. 6, 39120, Magdeburg, Germany

    Hans-Jochen Heinze

  4. Department of Orthopaedics, Klinikum Magdeburg GmbH, Birkenallee 34, 39130, Magdeburg, Germany

    Joerg Franke

Authors
  1. Imke Galazky
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  2. Christina Caspari
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Correspondence to Imke Galazky.

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Electronic supplementary material

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Supplementary material 1 (PPTX 266 kb)

586_2018_5748_MOESM2_ESM.docx

An overview and time course of surgical interventions as well as infiltrations in the PD cohort. Abbreviations: ASD (adjacent segment disease), CT (computed tomography), H&Y (Hoehn & Yahr stage), L3, 4, 5 (lumbar segments 3, 4, 5), S1 (sacral segment 1), PD (Parkinson’s disease), PLIF (posterior lumbar interbody fusion), TLIF (transforaminal lumbar interbody fusion). (DOCX 26 kb)

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Galazky, I., Caspari, C., Heinze, HJ. et al. The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson’s disease: implications on spinal surgery. Eur Spine J 27, 2847–2853 (2018). https://doi.org/10.1007/s00586-018-5748-0

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  • DOI: https://doi.org/10.1007/s00586-018-5748-0

Keywords

  • Low back pain
  • Lumbar degeneration
  • Parkinson’s disease
  • Adult spinal deformity