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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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Postsurgical images. (a) Antero-posterior view. (b) Lateral view. (c) Computed tomography scan lateral image. (d) Maximum extension position. The patient can stand alone gazing straight forward.
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Fig4: Postsurgical images. (a) Antero-posterior view. (b) Lateral view. (c) Computed tomography scan lateral image. (d) Maximum extension position. The patient can stand alone gazing straight forward.

Mentions: In detail, the patient was set in a prone position and underwent posterior fusion with L3-4 and L4-5 facetectomy first, to acquire mobility in the posterior part of the lower back. Pedicle screws were inserted transfascially at T10-L2 and L5-S1. The L3-5 lamina was exposed in the usual manner, and L3-4 and L4-5 facetectomy were performed. Then, the patient was set in a lateral position on his right. After the confirmation of L2-S vertebrae/sacrum, a 12-cm skin incision was made about 12 cm anterior to the marked L5-S1 disc space (Figure 3a). Regarding L2-3, L3-4, and L4-5, Crydesdale® cages were inserted using an OLIF retractor (L2-3: 10-mm height × 55-mm long; L3-4 and L4-5: 14-mm height × 55-mm long). After the OLIF procedure, the bifurcations of the aorta and vena cava were exposed for the following L5-S1 access, and then an anterior L5-S1 cage was inserted according to the previous procedure (Figure 3b) [4]. After the anterior fusion, the patient was set in the prone position again, and the pedicle screws were fixed with rods with compression at L3-5. The total surgical time was 5:07 (hr:min. first posterior, 1:37; anterolateral, 3:05; and second posterior, 1:25), and the intrasurgical blood loss was 360 g in total. Postsurgery, the patient was able to stand alone and still, and to gaze straight forward (Figure 4d). He experienced transient decrease in proximal muscle strength in his lower limb of contralateral side of the surgery (manual muscle test (MMT) grade 2 of 5 in iliopsoas and quadriceps muscles), which fully recovered to MMT grade 5 within 3 months after the surgery by daily muscle strengthening exercise and gait. In detail, He required a support of walker to stand still till the end of the 1 month after the surgery, and gradually acquired the ability of hip flexion. Once he acquired the proximal muscle power, he came to walk by himself day-by-day about 2.5 months after the surgery under the supervision of physical trainers. The transient muscle weakness was thought to be from some anatomical change in the nerves such as the corrected sagittal alignment. His presurgical symptoms of GERD have disappeared, and his SVA has improved from an estimated 540 mm to 212 mm just after the surgery, which is decreasing gradually together with the improving sagittal alignment and hip ROM. His LL, PT, and SS have improved to 29.5°, 39°, and 15.7°, respectively. Regardless of the non-fully restored postsurgical lordosis and SVA, the patient was satisfied with the surgical outcome, as he can now walk with only a cane, gazing straight forward for at least 30 minutes.Figure 3


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)

Postsurgical images. (a) Antero-posterior view. (b) Lateral view. (c) Computed tomography scan lateral image. (d) Maximum extension position. The patient can stand alone gazing straight forward.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Postsurgical images. (a) Antero-posterior view. (b) Lateral view. (c) Computed tomography scan lateral image. (d) Maximum extension position. The patient can stand alone gazing straight forward.
Mentions: In detail, the patient was set in a prone position and underwent posterior fusion with L3-4 and L4-5 facetectomy first, to acquire mobility in the posterior part of the lower back. Pedicle screws were inserted transfascially at T10-L2 and L5-S1. The L3-5 lamina was exposed in the usual manner, and L3-4 and L4-5 facetectomy were performed. Then, the patient was set in a lateral position on his right. After the confirmation of L2-S vertebrae/sacrum, a 12-cm skin incision was made about 12 cm anterior to the marked L5-S1 disc space (Figure 3a). Regarding L2-3, L3-4, and L4-5, Crydesdale® cages were inserted using an OLIF retractor (L2-3: 10-mm height × 55-mm long; L3-4 and L4-5: 14-mm height × 55-mm long). After the OLIF procedure, the bifurcations of the aorta and vena cava were exposed for the following L5-S1 access, and then an anterior L5-S1 cage was inserted according to the previous procedure (Figure 3b) [4]. After the anterior fusion, the patient was set in the prone position again, and the pedicle screws were fixed with rods with compression at L3-5. The total surgical time was 5:07 (hr:min. first posterior, 1:37; anterolateral, 3:05; and second posterior, 1:25), and the intrasurgical blood loss was 360 g in total. Postsurgery, the patient was able to stand alone and still, and to gaze straight forward (Figure 4d). He experienced transient decrease in proximal muscle strength in his lower limb of contralateral side of the surgery (manual muscle test (MMT) grade 2 of 5 in iliopsoas and quadriceps muscles), which fully recovered to MMT grade 5 within 3 months after the surgery by daily muscle strengthening exercise and gait. In detail, He required a support of walker to stand still till the end of the 1 month after the surgery, and gradually acquired the ability of hip flexion. Once he acquired the proximal muscle power, he came to walk by himself day-by-day about 2.5 months after the surgery under the supervision of physical trainers. The transient muscle weakness was thought to be from some anatomical change in the nerves such as the corrected sagittal alignment. His presurgical symptoms of GERD have disappeared, and his SVA has improved from an estimated 540 mm to 212 mm just after the surgery, which is decreasing gradually together with the improving sagittal alignment and hip ROM. His LL, PT, and SS have improved to 29.5°, 39°, and 15.7°, respectively. Regardless of the non-fully restored postsurgical lordosis and SVA, the patient was satisfied with the surgical outcome, as he can now walk with only a cane, gazing straight forward for at least 30 minutes.Figure 3

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