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Less invasive corrective surgery using oblique lateral interbody fusion (OLIF) including L5-S1 fusion for severe lumbar kyphoscoliosis due to L4 compression fracture in a patient with Parkinson's disease: a case report.

Wakita H, Shiga Y, Ohtori S, Kubota G, Inage K, Sainoh T, Sato J, Fujimoto K, Yamauchi K, Nakamura J, Takahashi K, Toyone T, Aoki Y, Inoue G, Miyagi M, Orita S - BMC Res Notes (2015)

Bottom Line: The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance.The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery.The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. moon_look359@yahoo.co.jp.

ABSTRACT

Background: Corrective surgery for kyphoscoliosis patients tend to be highly invasive due to osteotomy. The present case introduce less invasive corrective surgery using anterior oblique lateral interbody fusion (OLIF) technique.

Case presentation: An 80-year-old Japanese man with a history of Parkinson's disease presented to our hospital because of severe kyphoscoliosis and gait disturbance. Considering the postsurgical complications due to osteotomy, we performed an anterior-posterior combined corrective fusion surgery: OLIF of Lumbar (L) 2-3, L3-4, and L4-5 (Medtronic Sofamor Danek, Memphis, TN, USA) followed by L5-Sacral (S) 1 anterior lumbar fusion via the OLIF approach using an anterior intervertebral cage, and posterior L3-4 and L4-5 facetectomy and posterior fusion using percutaneous pedicle screws from Thoracic (T) 10 to S1 with a T-9 hook system. The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance. The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery.

Conclusion: The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

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Related in: MedlinePlus

Plain radiograph showed rigid kyphoscoliosis. (a) The antero-posterior view showed slight left-convex scoliosis with deformity. (b) Whole spinal lateral view. Note that the patient was only able to maintain the standing position with assistance; thus, the image is not a true whole-spinal image. (c) The lateral view at maximum extension hardly showed changes in alignment. (d) Computed tomography scan sagittal image. LL: lumbar lordosis, PI: pelvic incidence, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis.
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Fig2: Plain radiograph showed rigid kyphoscoliosis. (a) The antero-posterior view showed slight left-convex scoliosis with deformity. (b) Whole spinal lateral view. Note that the patient was only able to maintain the standing position with assistance; thus, the image is not a true whole-spinal image. (c) The lateral view at maximum extension hardly showed changes in alignment. (d) Computed tomography scan sagittal image. LL: lumbar lordosis, PI: pelvic incidence, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis.

Mentions: The patient’s physical examination revealed extremely decreased range of motion (ROM) in lumbar flexion and extension with no neurological disorder such as motor function loss and sensory disturbance. He presented limited hip extension because of the rigid long-term kyphoscoliosis. Radiographic findings of his thoracolumbar spine showed severe rigid kyphosis due to a Lumbar (L) 4 burst fracture (semiquantitative grade 3) with little ROM in extension/flexion (Figure 2a-c) with no episodes of fall or trauma that may have caused the L4 fracture. His bone mineral density was within a normal range with no evidence of osteoporosis. Sagittal alignment parameters were measured as: lumbar lordosis (LL) -39.7°, pelvic incidence (PI) 54°, sacral slope (SS) -11.7°, pelvic tilt (PT) 55°, and sagittal vertical axis (SVA) 330 mm. Regarding the SVA, the measured value was not true because the patient was unable to stand alone without assistance, and 540 mm was the estimated value by considering his physique. A computed tomography scan and magnetic resonance imaging showed invagination of the fractured posterior wall of the L4 vertebrae without harmful interruption in the spinal canal or foramen. The intervertebral discs of L1-2 and L4-5 showed degeneration with vacuum phenomenon (Figure 2d).Figure 2


Less invasive corrective surgery using oblique lateral interbody fusion (OLIF) including L5-S1 fusion for severe lumbar kyphoscoliosis due to L4 compression fracture in a patient with Parkinson's disease: a case report.

Wakita H, Shiga Y, Ohtori S, Kubota G, Inage K, Sainoh T, Sato J, Fujimoto K, Yamauchi K, Nakamura J, Takahashi K, Toyone T, Aoki Y, Inoue G, Miyagi M, Orita S - BMC Res Notes (2015)

Plain radiograph showed rigid kyphoscoliosis. (a) The antero-posterior view showed slight left-convex scoliosis with deformity. (b) Whole spinal lateral view. Note that the patient was only able to maintain the standing position with assistance; thus, the image is not a true whole-spinal image. (c) The lateral view at maximum extension hardly showed changes in alignment. (d) Computed tomography scan sagittal image. LL: lumbar lordosis, PI: pelvic incidence, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389863&req=5

Fig2: Plain radiograph showed rigid kyphoscoliosis. (a) The antero-posterior view showed slight left-convex scoliosis with deformity. (b) Whole spinal lateral view. Note that the patient was only able to maintain the standing position with assistance; thus, the image is not a true whole-spinal image. (c) The lateral view at maximum extension hardly showed changes in alignment. (d) Computed tomography scan sagittal image. LL: lumbar lordosis, PI: pelvic incidence, SS: sacral slope, PT: pelvic tilt, SVA: sagittal vertical axis.
Mentions: The patient’s physical examination revealed extremely decreased range of motion (ROM) in lumbar flexion and extension with no neurological disorder such as motor function loss and sensory disturbance. He presented limited hip extension because of the rigid long-term kyphoscoliosis. Radiographic findings of his thoracolumbar spine showed severe rigid kyphosis due to a Lumbar (L) 4 burst fracture (semiquantitative grade 3) with little ROM in extension/flexion (Figure 2a-c) with no episodes of fall or trauma that may have caused the L4 fracture. His bone mineral density was within a normal range with no evidence of osteoporosis. Sagittal alignment parameters were measured as: lumbar lordosis (LL) -39.7°, pelvic incidence (PI) 54°, sacral slope (SS) -11.7°, pelvic tilt (PT) 55°, and sagittal vertical axis (SVA) 330 mm. Regarding the SVA, the measured value was not true because the patient was unable to stand alone without assistance, and 540 mm was the estimated value by considering his physique. A computed tomography scan and magnetic resonance imaging showed invagination of the fractured posterior wall of the L4 vertebrae without harmful interruption in the spinal canal or foramen. The intervertebral discs of L1-2 and L4-5 showed degeneration with vacuum phenomenon (Figure 2d).Figure 2

Bottom Line: The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance.The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery.The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. moon_look359@yahoo.co.jp.

ABSTRACT

Background: Corrective surgery for kyphoscoliosis patients tend to be highly invasive due to osteotomy. The present case introduce less invasive corrective surgery using anterior oblique lateral interbody fusion (OLIF) technique.

Case presentation: An 80-year-old Japanese man with a history of Parkinson's disease presented to our hospital because of severe kyphoscoliosis and gait disturbance. Considering the postsurgical complications due to osteotomy, we performed an anterior-posterior combined corrective fusion surgery: OLIF of Lumbar (L) 2-3, L3-4, and L4-5 (Medtronic Sofamor Danek, Memphis, TN, USA) followed by L5-Sacral (S) 1 anterior lumbar fusion via the OLIF approach using an anterior intervertebral cage, and posterior L3-4 and L4-5 facetectomy and posterior fusion using percutaneous pedicle screws from Thoracic (T) 10 to S1 with a T-9 hook system. The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance. The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery.

Conclusion: The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

Show MeSH
Related in: MedlinePlus