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Spinal surgery in patients with Parkinson's disease: unsatisfactory results, failure and disappointment.

Sapkas G, Lykomitros V, Soultanis K, Papadopoulos EC, Papadakis M - Open Orthop J (2014)

Bottom Line: Failure and re -operation are frequent outcomes.Re - operations were performed in 5 patients, while clinical and radiological results were poor in the majority of cases.This particular group of patients should be informed of the increased risk of failure and be closely followed - up on a regular basis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Faculty of Medicine, University of Athens, Greece.

ABSTRACT
Previous studies on spinal surgery in PD patients report an exceptionally high rate of complications. Failure and re -operation are frequent outcomes. This is a retrospective case series with the aim of establishing the rate of complications in patients with concomitant Parkinson's disease. Ten patients were subjected to spinal surgery from 2005 to 2009. The indications and type of operation varied. Cases of Failed Back Surgery and re-operation were sought. Follow - up was between 6 - 42 months. All 10 patients presented some clinical or radiological complication. The most common complications were screw pull - out and progressive spinal deformity. Re - operations were performed in 5 patients, while clinical and radiological results were poor in the majority of cases. Patients with Parkinson's disease have a very high complication rate and often have to undergo revision surgery. This particular group of patients should be informed of the increased risk of failure and be closely followed - up on a regular basis.

No MeSH data available.


Related in: MedlinePlus

Same patient as Fig. (1) after revision surgery. Notice extension of fusion into L4.
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Figure 2: Same patient as Fig. (1) after revision surgery. Notice extension of fusion into L4.

Mentions: Ultimately, all 10 patients developed some form of surgery- related complication. 5 of the 10 patients had to undergo additional surgery (Figs. 1, 2). Of these, three patients were complicated by hardware failure and had revision surgery, with one developing adjacent segment disease (ASD) in addition to screw pullout. One patient developed ASD without associated hardware failure and also underwent revision surgery. Lastly, one patient sustained fractures in two vertebrae, one distant to and one at the proximal end of the fusion. That same patient sustained two further vertebral fractures one year after being treated with kyphoplasty. Of the 5 patients that were not re – operated, 2 developed severe camptocormia despite solid fusion, one developed flat – back deformity and was lost to follow-up and one developed proximal junctional kyphosis but declined further surgery. Overall, hardware failure in the form of screw pull – out occurred in 30% of patients, adjacent segment disease in 30% and vertebral fractures in 10% (one patient). There was loss of sagittal balance in 100% of patients, even in the presence of a solid fusion. Revision surgery was performed in 50% of the patients, as a result of hardware failure in 30%, worsening kyphosis in 10% and vertebral fracture in 10%.


Spinal surgery in patients with Parkinson's disease: unsatisfactory results, failure and disappointment.

Sapkas G, Lykomitros V, Soultanis K, Papadopoulos EC, Papadakis M - Open Orthop J (2014)

Same patient as Fig. (1) after revision surgery. Notice extension of fusion into L4.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4157348&req=5

Figure 2: Same patient as Fig. (1) after revision surgery. Notice extension of fusion into L4.
Mentions: Ultimately, all 10 patients developed some form of surgery- related complication. 5 of the 10 patients had to undergo additional surgery (Figs. 1, 2). Of these, three patients were complicated by hardware failure and had revision surgery, with one developing adjacent segment disease (ASD) in addition to screw pullout. One patient developed ASD without associated hardware failure and also underwent revision surgery. Lastly, one patient sustained fractures in two vertebrae, one distant to and one at the proximal end of the fusion. That same patient sustained two further vertebral fractures one year after being treated with kyphoplasty. Of the 5 patients that were not re – operated, 2 developed severe camptocormia despite solid fusion, one developed flat – back deformity and was lost to follow-up and one developed proximal junctional kyphosis but declined further surgery. Overall, hardware failure in the form of screw pull – out occurred in 30% of patients, adjacent segment disease in 30% and vertebral fractures in 10% (one patient). There was loss of sagittal balance in 100% of patients, even in the presence of a solid fusion. Revision surgery was performed in 50% of the patients, as a result of hardware failure in 30%, worsening kyphosis in 10% and vertebral fracture in 10%.

Bottom Line: Failure and re -operation are frequent outcomes.Re - operations were performed in 5 patients, while clinical and radiological results were poor in the majority of cases.This particular group of patients should be informed of the increased risk of failure and be closely followed - up on a regular basis.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Faculty of Medicine, University of Athens, Greece.

ABSTRACT
Previous studies on spinal surgery in PD patients report an exceptionally high rate of complications. Failure and re -operation are frequent outcomes. This is a retrospective case series with the aim of establishing the rate of complications in patients with concomitant Parkinson's disease. Ten patients were subjected to spinal surgery from 2005 to 2009. The indications and type of operation varied. Cases of Failed Back Surgery and re-operation were sought. Follow - up was between 6 - 42 months. All 10 patients presented some clinical or radiological complication. The most common complications were screw pull - out and progressive spinal deformity. Re - operations were performed in 5 patients, while clinical and radiological results were poor in the majority of cases. Patients with Parkinson's disease have a very high complication rate and often have to undergo revision surgery. This particular group of patients should be informed of the increased risk of failure and be closely followed - up on a regular basis.

No MeSH data available.


Related in: MedlinePlus