title: Pathologic thoracic spine fracture in presence of Parkinson's disease and diffuse ankylosis: successful management of a challenging condition.
abstract: BACKGROUND
  Patients with Parkinson's disease have higher risk of complications and revision surgery following spine surgery. Spinal fracture in an ankylosed spine is also difficult to treat. We recently treated a case of thoracic spine fracture in a patient with Parkinson's disease complicating a severely ankylosed spine. There is no report describing surgical treatment of spine fracture in such a difficult condition, thus, we firstly report the case and discuss the reasons for a successful result.
  
  
  METHODS
  A 68-year-old man with Parkinson's disease had a pathologic thoracic spine fracture at T11. Four days after onset, he was referred to a local hospital because of gradually increasing back pain, but no spinal fracture was pointed out at that time. Because he developed lower extremity bilateral numbness and weakness, he was transported to our hospital, eight days after onset. When referred to our hospital, he exhibited severe back pain and paralysis of the lower extremities due to spinal cord involvement. Emergency surgery was performed. Decompression of T10-11 was performed followed by instrumented spinal fusion from T8 to L2. A dramatic neurological improvement was observed following surgery, and complete bony fusion was achieved. At the final two-year postoperative follow-up, the patient had no pathological symptoms related to spinal fracture and no instrument failure was observed.
  
  
  CONCLUSIONS
  This patient had Parkinson's disease and a severely ankylosed spine, both of which may lead to unsatisfactory surgical results from spinal surgery. Generally, patients with Parkinson's disease have an increased risk for adjacent segment disease and instrument failure. In this patient, fusion surgery did not change the number of fused segments because operated segments were already ankylosed. Because no stress force exists between adjacent vertebral bodies, a severely ankylosed spine may help prevent screw pullout. Thus, treatment of a spinal fracture in an ankylosed spinal segment is a less adverse condition for patients with Parkinson's disease. Our experience led us to think that a combination of Parkinson's disease with severely ankylosed spine does not necessarily suggest unsatisfactory outcomes after surgical treatment of spinal fracture.
authors: Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 654-1 Shimoshizu, Sakura, Chiba 285-8741, Japan. yasuaoki35@fc4.so-net.ne.jp
authors: Yasuchika
authors: Y
authors: Aoki
authors: Arata
authors: A
authors: Nakajima
authors: Ryuji
authors: R
authors: Sakakibara
authors: Seiji
authors: S
authors: Ohtori
authors: Kazuhisa
authors: K
authors: Takahashi
authors: Koichi
authors: K
authors: Nakagawa
mesh_terms: D000368:Aged; D000844:Ankylosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001416:Back Pain / Q000209:etiology; D019299:Decompression, Surgical; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010300:Parkinson Disease / Q000150:complications*; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references: J Spinal Disord Tech. 2012 Oct;25(7):351-5
references: 21685805
references: Patient Saf Surg. 2008 Jun 06;2:15
references: 18538019
references: Nucl Med Commun. 1994 Mar;15(3):173-7
references: 8190408
references: Spinal Cord. 1999 Jun;37(6):444-7
references: 10432265
references: J Neurosurg. 2002 Sep;97(2 Suppl):218-22
references: 12296682
references: Orthopedics. 2009 Oct;32(10):
references: 19824600
references: Eur Spine J. 2009 Feb;18(2):145-56
references: 18791749
references: Spine (Phila Pa 1976). 2004 Sep 15;29(18):2006-12
references: 15371701
references: Spine (Phila Pa 1976). 1988 Jul;13(7):763-6
references: 3194784
references: Spine (Phila Pa 1976). 2010 May 15;35(11):E458-64
references: 20421858
references: Eur Spine J. 2010 Oct;19(10):1785-94
references: 20422434
references: Spine (Phila Pa 1976). 2007 Dec 15;32(26):2989-95
references: 18091492
references: Neurosurg Focus. 2008;24(1):E12
references: 18290738
references: Mov Disord. 1993 Oct;8(4):507-11
references: 8232362
references: Reumatol Clin. 2012 Mar-Apr;8(2):100-1
references: 22089063
references: Neurosurg Focus. 2008;24(1):E6
references: 18290744