May 2024

NEUROSCIENCES

COMPLEX SPINAL FUSION FOR PARKINSON’S DISEASE-RELATED KYPHOSIS

By: Tyler R. Koski, MD
 
A 69-year-old male patient presented with debilitating kyphosis secondary to Parkinson’s disease. The pronounced forward curvature of the spine, known as camptocormia, severely restricted his mobility and daily activities. He reported chronic back pain, rapid fatigue and early satiety due to abdominal compression. Comprehensive imaging, including X-rays and MRI, revealed significant lumbar disc degeneration and severe thoraco-lumbar kyphosis. These findings corroborated the clinical presentation of sagittal imbalance.
 
Surgical intervention was necessary to restore upright posture and alleviate symptoms, and it used a two-step spinal fusion approach. The patient was positioned supine for the initial step, which involved anterior lumbar interbody fusion (ALIF) through the abdomen. The procedure included removing degenerated L4-L5 and L5-S1 discs, and inserting a polyether ether ketone (PEEK) cages to restore disc height and spinal alignment. Additional anterior fixation with screws through the cage’s metal endplate was performed to enhance stability at the base of the planned construct.​

Two days post-ALIF, the patient underwent an extensive posterior approach for further stabilization. He underwent a posterior instrumented fusion from T2 to S1 and ilium with multiple levels of posterior column osteotomies. Careful realignment was achieved, and a tapering rod was utilized to help transition the forces. Parkinson’s disease and camptocormia are associated with high revision rates, and the patient’s care team paid careful attention to construct stiffness and alignment to help mitigate that risk. Autologous bone grafting was milled for optimal fusion substrate. Meticulous hemostasis and nerve root preservation were maintained throughout the procedure. 

​Postoperative CT scans and standing X-rays validated the optimal positioning of hardware and restoration of spinal curvature.
 
The patient exhibited a marked improvement in posture and function. The sagittal plane imbalance was rectified, significantly improving his quality of life. Despite the expected reduction in spinal flexibility, the patient reported substantial relief from previous symptoms and a return to more normal daily activities. He continues to do well and has not required further intervention, now four years out from the procedure.​
​This case underscores the complexity of spinal deformities in Parkinson’s disease and the need for a tailored surgical approach. The success of this procedure is attributed to the precise execution of both anterior and posterior fusion techniques, as well as the vigilant preservation of neurological structures. The multidisciplinary effort was pivotal in achieving the desired outcome.
Tyler R. Koski, MD, co-director of the Northwestern Medicine Center for Spine Health and associate professor of Neurological Surgery and Orthopaedic Surgery at Northwestern Medicine.

Refer a Patient

Northwestern Medicine welcomes the opportunity to partner with you in caring for your patients. ​

You May Also Like