Spinal Deformity and Parkinson Disease: A Treatment Algorithm

Cheerag D. Upadhyaya, M.D.; Philip A. Starr, M.D., Ph.D.; Praveen V. Mummaneni, M.D.

Disclosures

Neurosurg Focus. 2010;28(3):E5 

In This Article

Abstract and Introduction

Abstract

Object. The authors review the literature on the treatment of spinal deformity in patients with Parkinson disease (PD) and formulate a treatment algorithm.
Methods. The authors provide representative cases of patients with PD and spinal deformity who underwent deep brain stimulation (DBS) or spinal surgery.
Results. In patients with PD and spinal deformity who undergo spinal surgery there is a high rate of acute and delayed complications. Patients who undergo DBS, while having significantly fewer complications, often do not regain sagittal balance.
Conclusions. Cases involving PD and camptocormia have a high rate of complications when spinal surgery is performed. The authors prefer to offer spinal surgery only to patients with coexisting spinal stenosis causing radiculopathy or myelopathy. Patients with PD and camptocormia without spinal stenosis may be considered for DBS, but the results are mixed.

Introduction

Parkinson disease is a neurodegenerative disorder that affects over 1 million people in the US.[19] It is estimated that the lifetime risk of developing PD is 1.5%.[7,10] With the aging of the US population, the prevalence of PD will likely continue to grow.[35] A recent estimate of the prevalence of deformities (involuntary trunk flexion/camptocormia, anterocollis, scoliosis) in PD was 33.5%.[2]

The cardinal motor signs of PD are 4–6-Hz resting tremor, rigidity, bradykinesia, and gait disorder/postural instability. Other symptoms include stooped posture, hypophonia, and paucity of facial expression. However, it can be difficult to diagnose PD correctly, and the early signs of PD can often be subtle. This has particular relevance when trying to understand the impact of surgical interventions on this population.[19] In the later stages of PD, the patients have a risk of developing dementia.[1,22] The dementia may contribute to death due to PD.[21]

Patients with PD may present with postural deformities. Several factors can contribute to postural instability including axial rigidity, poor trunk coordination, orthostatic hypotension, and difficulty integrating various sensory inputs. The postural instability contributes to increasing difficulty with transfers, gait, ability to live independently at home, and falls.[5]

A number of spinal deformities have been described in association with PD. The stooped posture classically associated with PD is the most common abnormality. Other disorders include camptocormia, myopathy-induced postural deformity, Pisa syndrome, and degenerative scoliosis. Here, we review the literature on surgical treatment of spinal deformity in patients with PD, including effects of DBS and spinal instrumentation.

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