title: Coronal plane spinal malalignment and Parkinson's disease: prevalence and associations with disease severity.
abstract: BACKGROUND
  Parkinson's disease (PD) is a progressive degenerative disorder of the central nervous system. Patients with PD often present with abnormal posturing.
  
  
  OBJECTIVE
  To investigate coronal plane deformities in patients with PD, and to evaluate the correlation between clinical features, coronal parameters related to spine alignment, and disease severity.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Eighty-nine patients with PD and 89 controls were included.
  
  
  METHODS
  A medical history was collected from the medical records.
  
  
  METHODS
  This study was a prospective assessment of consecutive patients with PD. Clinical and demographic parameters were collected from medical records and outpatient interviews. Full-length standing anteroposterior and lateral spine radiographs were used to assess the spinal parameters. The threshold for scoliosis was set at a 10° Cobb angle, and the curve type was classified using Schwab classification.
  
  
  RESULTS
  A total of 178 patients (89 in PD and 89 in control groups) were included. Scoliosis was identified in 27 patients (30%) and 22 controls (p=.502). However, coronal imbalance was more common in patients with PD than in controls (11 vs. 0 patients, p=.001). Scoliosis was more common in women than in men (male:female=8:19, p=.04). Back pain was more common in patients with scoliosis than in those without scoliosis (14 of 27 vs. 17 of 62, p=.036). Schwab Type IV (thoracolumbar major) was the most common type of scoliosis in patients with PD and Type V (lumbar major) was the most common type in controls. With adjustment for patient age and gender, multiple linear regression analysis revealed that severity of PD (Unified Parkinson's Disease Rating Scale, p=.037) and magnitude of global coronal malalignment (p=.003) were associated with the scoliosis Cobb angle (p=.037, B=0.139). Direction of scoliosis and side of global coronal malalignment were not significantly correlated with the laterality of predominant PD symptoms (p>.05).
  
  
  CONCLUSIONS
  Global coronal malalignment is more prevalent in patients with PD than in controls. Greater severity of PD was significantly associated with greater magnitude of scoliosis Cobb angle, even after adjusting for the effects of patient age and gender. However, direction of scoliosis and side of global coronal malalignment were not significantly associated with the dominant laterality of PD symptoms.
authors.affiliation: Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea.
authors.forename: Hong June
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Virginia, 914 E Jefferson St., Charlottesville, VA 22902, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA.
authors.forename: Virginie C
authors.initials: VC
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 333 E 38th St. Fl 4, New York, NY 10016, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Department of Neurosurgery, University of California San Francisco, 220 Montgomery St., San Francisco, CA 94104, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi Shinjuku, Tokyo, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, Korea.
authors.forename: Jong Sam
authors.initials: JS
authors.lastname: Baik
authors.affiliation: Department of Neurosurgery, College of Medicine, Yonsei University, Seodaemun-gu, Seoul, Korea. Electronic address: yoonhaucsf@gmail.com.
authors.forename: Yoon
authors.initials: Y
authors.lastname: Ha
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology*; D011187:Posture / Q000502:physiology*; D015995:Prevalence; D011446:Prospective Studies; D011859:Radiography; D012600:Scoliosis / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D012737:Sex Factors; D013131:Spine / Q000000981:diagnostic imaging*
keywords: Parkinson's disease; Pelvic parameters; Pelvic tilt; SVA; Sagittal alignment; Spinal deformity