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.
Keywords
parkinson's disease - spine surgery - thoracolumbar spine - instrumentation - revision
