STUDY DESIGN: Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD). OBJECTIVE: To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction. SUMMARY OF BACKGROUND DATA: The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PD patients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum. METHODS: : This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire. RESULTS: The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition. CONCLUSIONS: This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.
STUDY DESIGN: Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD). OBJECTIVE: To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction. SUMMARY OF BACKGROUND DATA: The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PDpatients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum. METHODS: : This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire. RESULTS: The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition. CONCLUSIONS: This is the first reported series of PDpatients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.
Authors: Rafael De la Garza Ramos; C Rory Goodwin; Amit Jain; Daniel Martinez-Ramirez; Isaac O Karikari; Daniel M Sciubba Journal: J Spine Surg Date: 2017-12