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

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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Fig. 1
Fig. 2

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

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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