title: Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease: a retrospective review with analysis of complications.
abstract: METHODS
  Description of the surgical management of major spinal deformities in patients with Parkinson disease (PD).
  
  
  OBJECTIVE
  To evaluate the effectiveness of the construct, the incidence and types of complications, and patient satisfaction.
  
  
  BACKGROUND
  The association of degenerative, neuromuscular, and osteoporotic diseases in PD can lead to major complications after spine surgery. We treated PD patients with major spinal deformities by a posterior-only approach for spinal fusion from T2 to the sacrum.
  
  
  METHODS
  : This retrospective study reviews 12 consecutive patients with PD undergoing this surgery in a 2-year span at a single institution. Radiographs were taken with the EOS low-dose system (EOS Imaging, Paris, France) before and 3 months after surgery and at the last follow-up visit and were evaluated by a spine surgeon not involved in the surgery. Complications were analyzed. The functional outcome was assessed with the SRS-30 questionnaire.
  
  
  RESULTS
  The patients' mean age was 68±6.2 years, the mean duration of PD 10±4.9 years, and the mean follow-up 32.8±6.9 months. Six patients had first surgeries, and 6 revisions. Statistically significant improvement was observed in all patients in the frontal and the sagittal planes after surgery. The sagittal vertical axis improved from 15.2±9.3 cm preoperatively to 0.5±3.2 cm at the last follow-up. Six patients had revision, 3 times for instrumentation failure, twice for proximal junctional kyphosis at T1-T2, and once for an epidural hematoma. The SRS-30 questionnaire indicated strong patient satisfaction, with 11 patients who would have the same procedure again if they had the same condition.
  
  
  CONCLUSIONS
  This is the first reported series of PD patients undergoing posterior spinal fusion from T2 to the sacrum for major deformities. This study indicates that good correction of sagittal and frontal balance enables good clinical and radiologic results that remain stable over time even when complications occur.
authors.affiliation: Orthopedic Spinal Surgery Unit, Bordeaux Pellegrin Hospital, Place Amélie Rabat Léon, Bordeaux, France. anouar.bourghli@gmail.com
authors.forename: Anouar
authors.initials: A
authors.lastname: Bourghli
authors.forename: Patrick
authors.initials: P
authors.lastname: Guérin
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Vital
authors.forename: Nicolas
authors.initials: N
authors.lastname: Aurouer
authors.forename: Stéphane
authors.initials: S
authors.lastname: Luc
authors.forename: Olivier
authors.initials: O
authors.lastname: Gille
authors.forename: Vincent
authors.initials: V
authors.lastname: Pointillart
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery*; D013121:Spinal Curvatures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome