Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson\u2019s disease

Hideaki Nakajima,Arisa Kubota,Shuji Watanabe,Kazuya Honjoh,Akihiko Matsumine

doi:10.1038/s41598-021-93798-1

Hideaki Nakajima, Arisa Kubota + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-93798-1

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Journal: Scientific Reports	Publication Date: Jul 9, 2021
Citations: 2	License type: open-access

Affiliation: University of Fukui

Abstract

Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.

Highlights

Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common
There were no significant differences in gender, mean age at the time of surgery, history of other fragility fractures, comorbidities, steroid intake, medication for osteoporosis, affected vertebra levels, surgical procedures, and Japanese Orthopaedic Association (JOA) scores before and after surgery in PD and non-PD patients
This study showed important differences in low lumbar OVC in patients with or without PD

Summary

Introduction

Osteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). Low lumbar OVC is frequently found in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with thoracolumbar junction collapse[3]. PD affects 1% of the population over age 60 and up to 4% over age 80, and the prevalence generally increases with a ge[6] Both OVC and PD are age-related diseases with low bone quality. Higher rates of postoperative complications and revision surgeries have been reported after spine surgery for patients with PD, such as fusion surgery for degenerative diseases and thoracolumbar OVC. We hypothesized that the different clinical and imaging features in patients with low lumbar OVC with and without PD may be related to neurological symptoms. We examined these relationships, with the goal of proposing appropriate surgical treatments

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