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Failure and Success of Spinal Surgery in Patients with Parkinson's Disease ‐ A Critical Case Series Review in Light of Sagittal Balance: Poster #3

Koller, Heiko MD (German Scoliosis Center); Zenner, Juliane MD; Hempfing, Axel MD; Ondra, Stephen L. MD; Koski, Tyler MD; Acosta, Frank L. MD; Ferraris, Luis MD; Meier, Oliver MD

Spine Journal Meeting Abstracts: September 2009 - Volume 10 - Issue - p 136
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Introduction; There are few data concerning biomechanical challenges spine surgeons face if treating patients with Parkinson's disease (PPD). We recognized PPD suffering spinal deformity aggravated by burden of PD stress the principles of sagittal balance if treated surgically indicating further investigation.

Methods; Retrospective series of 23 PPD treated surgically. ASA score was ø2.3. Outcome analysis included review of med records focusing on failure characteristics, complications & radiographic analysis of balance parameters.

Results; 15 fem., 8 male PPD w/ age ø66.3years at index surg, 67.9y at follow‐up of ø14.5months; mid‐ to long‐term (MLT) data available in 17 pat (73.9%). 10 pat (43.5%) presented w/ failed previous surg. 18 pat (78.3%) underwent multilevel surgery. 16 pat (69.6%) had fusion to S1‐S2‐llium. Med. complications occured in 7 pat (30.4%), surgical in 12 pat (52.2%). Adjacent segment fractures occurred in 3 of 17 pat (17.6%) w/ MLT‐data. Lumbar lordosis L1‐S1 was 38.8°, 46.0° and 45.3°. C7‐sagittal plumb‐line was 12.2cm (8–57), 6.9cm and 7.6cm, resp. 3 of 17 pat (17.6%) had proximal junctional kyphosis (PJK >10°). 5 pat of 20 pat (25%) w/ MTL‐data had a positive C7 off‐set of >10cm, indicating revision in 4 cases (80%). 6 of 18 (33.3%) had any early perioperative or late revision after index surgery. Fusion was achieved in 10 of 17 pat (58.8%) with MLTdata. Number of patients satisfied/very satisfied was 15 of 17 (88.2%).

Conclusion; The surgical history of PPD treated for spinal disorder and the reasons indicating redo surgery for recalcitrant sagittal imbalance in our sample highlight the mainstays of surgery in PPD: If spinal surgery is indicated, reconstruction of spino‐pelvic balance w/ focus on lumbar lordosis & global sagittal alignment is mandatory. If short segment surgery is scheduled in PPD w/ sagittal decompensated imbalance, failure of instrumentation, fusion & decompression is likely.

Significance: Treatment of spinal disorders in PPD is troublesome due to biomechanical challenges imposed by postural dysfunction due to neuromusc. disorder and sagittal imbalance. Besides focus on local disease, decision making in PPD has to address primarily concerns of global imbalance, frequently indicating fusion into the thoracic spine to succeed.

© 2009 Lippincott Williams & Wilkins, Inc.