Sagittal imbalance, muscle atrophy, and osteoporosis: risk factors for revision posterior lumbar fusion surgery in patie
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ORIGINAL PAPER
Sagittal imbalance, muscle atrophy, and osteoporosis: risk factors for revision posterior lumbar fusion surgery in patients with Parkinson’s disease Hao-Wei Xu 1 & Yu-Yang Yi 1 & Yu-Zhi Li 1 & Shu-Bao Zhang 1 & Shan-Jin Wang 1 & De-Sheng Wu 1 Received: 13 February 2020 / Accepted: 11 June 2020 # SICOT aisbl 2020
Abstract Objective The aim of our study was to evaluate features and complications of patients with Parkinson’s disease (PD) who underwent posterior lumbar fusion surgery for lumbar degenerative diseases (LDD), as well as the risk factors for revision. Methods Between January 2010 and December 2016, 132 patients were retrospectively identified for inclusion. Patients were divided into a 29 revision PD group and a 103 non-revision PD group. Patient factors included bone mineral density (BMD) and severity of PD using the Hoehn and Yahr staging system. Surgical factors included surgical levels and fusion methods. Radiographic measurements included pre-operative spinopelvic parameters, paraspinal muscle atrophy, and fatty infiltration. Logistic regression analysis was used to determine independent predictors for revision posterior lumbar fusion. Results The average age of the PD patients was 67.96 years, and the follow-up time was 49.01 months. R-PD patients accounted for 21.97% of all PD patients who underwent lumbar fusion surgery. Multivariable analysis indicated that low BMD (p = 0.012), fatty infiltration (p = 0.038), a smaller relative cross-sectional area (rCSA) of the paraspinal muscle (p = 0.008), larger pelvic incidence-lumbar lordosis (PI-LL) (p = 0.01), and sagittal vertical axis (SVA) (p = 0.004) were significant independent risk factors for revision posterior lumbar fusion in PD patients. Conclusion PD patients with low pre-operative BMD, fatty infiltration, a smaller rCSA of the paraspinal muscle, and larger PI-LL and SVA had a higher rate of revision lumbar fusion. Maintaining sagittal balance, functional exercises, and anti-osteoporosis treatment were important in preventing complications in PD patients. Keywords Sagittal imbalance . Muscle atrophy . Osteoporosis . Risk factors . Revision . Parkinson’s disease
Introduction Parkinson’s disease (PD), also known as “paralytic tremor,” is a common degenerative disease of the nervous system and is common in the elderly. The disease has characteristic motor symptoms, including quiescence tremor, motion retardation, myotonia, and postural balance issues [1]. It is also accompanied by non-characteristic motor symptoms, such as constipation, olfaction disorders, sleep disorders, autonomic nerve
Hao-Wei Xu and Yu-Yang Yi are co-first authors. * Shan-Jin Wang [email protected] 1
Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
disorders, and cognitive disorders [2]. Due to postural balance disorders in most Parkinson’s patients, long-term abnormal activities tend to lead to spinal stenosis, scoliosis, kyphosis, osteoporotic fractures, and other symptoms [3]. These lumbar degen
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