Operative treatment of degenerative spinal disease with concomitant Parkinson’s disease – cases report

Introduction. Degenerative spine disease (DSD) with spinal stenosis disturbs sagittal profile of the spine, by reducing lumbar lordosis which may alter normal gait leading to neurogenic claudication. On the other hand, Parkinson’s disease (PD), a progressive neurodegenerative process also largely alters spinal sagittal balance and influences physiological gait. A coexistence of these two morbidities raises a particular challenge for the spine surgeon. Aim. The aim of the study is to present the results of surgical treatment of patients with lumbar spinal stenosis with concomitant Parkinson’s disease. Material and methods. We analysed the course of treatment of 7 patients with DSD and symptomatic lumbar spinal stenosis with concomitant PD. The course of surgery was analysed, presence of all complications was noted. Clinical evaluation based on assessing pain intensity levels and pain-free walking distance prior and after surgical treatment. Besides that, radiographic evaluation was performed and consisted of lumbo-sacral sagittal balance parameters (lordosis angle between L1 and L5 (LL), thoraco-lumbar junction angle measured between Th11 and L2 (TL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT). Results. Mean age at surgery was 65.4 years (56-74), the duration of PD prior to surgery was 5 years (1-11). Only in two patients one surgery was sufficient to decrease the symptoms. The remaining 5 patients required revision surgery in all, but one cases due to instrumentation failure. A total of 13 revision surgeries were performed. Primary surgical treatment in all cases consisted of decompression of neural structures with instrumented fusion in 6 cases, and without instrumentation in one case. The level of back pain according to VAS before surgery averaged 5.3 and decreased during the last follow-up to 2.6. The severity of leg pain before surgery averaged 3.6 and decreased to 2.1 during last follow-up. Preoperatively all patients presented a mismatch between LL and PI, which increased after surgery due to a postoperative LL reduction. Conclusions. Surgical treatment of lumbar stenosis in patients with Parkinson’s disease is burdened with a significant risk of complications. The most common cause of reoperation in these patients is destabilization of instrumentation and progression of sagittal balance malalignment.