Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study

Abstract

Background With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. Methods In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. Results We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). Conclusion PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.

Improvement in sagittal alignment and mechanical low-back pain following deep brain stimulation for Parkinson’s disease: illustrative case

“…It has been well reported in the literature that patients with PD have increased complications from spine surgery and high reoperation rates. 12–14 Sheu et al 13 examined 66 patients with PD who underwent spine surgeries at their institution and found that 29% of patients required revision surgery. They also reported that instrumentation of more than three surgical levels and patients undergoing corrective osteotomies had earlier reoperations.…”

Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

“…With the increasing prevalence of PD and the associated degenerative spinal conditions, the demand for spinal surgery in patients with PD increases rapidly. However, the results of spinal surgery for degenerative spinal conditions in patients with PD are disappointing with failure rates of 25.8-100% [8][9][10][11][12]. As an alternative treatment strategy for the underlying pathomechanism, some authors have described the influence of deep brain stimulation on PD-related postural abnormalities [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”