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J Neurol Surg A Cent Eur Neurosurg 2023; 84(03): 247-254
DOI: 10.1055/s-0041-1741535
Original Article

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

Philipp Spindler 
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Dimitri Tkatschenko
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Yasmin Alzoobi
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Dorothee Kuebler
2   Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany
,
Andrea A. Kühn
2   Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany
,
Gerd-Helge Schneider
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Vincent Prinz
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Peter Vajkoczy
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
,
Katharina Faust
1   Department of Neurosurgery, Charité – University Medicine Berlin, Berlin, Germany
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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


Publication History

Received: 04 May 2021

Accepted: 12 November 2021

Article published online:
31 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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