title: Lumbar Spinal Surgery in Patients With Parkinson Disease: A Multicenter Retrospective Study.
abstract: METHODS
  A multicenter, retrospective study.
  
  
  OBJECTIVE
  To identify the factors that affect surgery-related complications and to clarify the surgical strategy for treating lumbar disorders in Parkinson disease (PD).
  
  
  BACKGROUND
  Previous studies have reported a high complication rate for spinal surgery in patients with PD. Because of the limited number of studies, there are no guidelines for spinal surgery for PD patients.
  
  
  METHODS
  We retrospectively reviewed the records for 67 PD patients who underwent lumbar spinal surgery. The patients were divided into 3 groups: 12 patients underwent laminectomy (Laminectomy), 24 underwent fusion surgery (Fusion) for lumbar canal stenosis, and 31 underwent corrective surgery for spinal deformity (Deformity). We assessed surgery-related complications in each group. The Cox proportional hazards model was used to identify the factors that predicted surgical failure.
  
  
  RESULTS
  The percentages of patients who experienced failure of the initial surgery were 33.3% in the Laminectomy group, 45.8% in the Fusion group, and 67.7% in the Deformity group. The rates of implant failure were high in the Fusion and Deformity groups (33.3% and 38.7%, respectively). The Deformity group had a high rate of postoperative fracture (41.9%). These complications occurred at the most caudal site within a year after surgery and resulted in progression of kyphotic deformity. Multivariate analysis revealed that preoperative lumbar lordosis angle (LL) (per -1 degree) was associated with a failure of the initial surgery (hazard ratio, 1.024; 95% confidence interval, 1.008-1.04; P=0.003).
  
  
  CONCLUSIONS
  We have demonstrated that a small preoperative LL increases the risk for failure of the initial surgery. Attaining and maintaining the proper lumbar lordosis with rigid fixation may be necessary in PD patients with a small preoperative LL.
authors.affiliation: *Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University †Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto ‡Department of Orthopedic Surgery, Kurashiki Central Hospital, Okayama §Department of Orthopedic Surgery, Kyoto City Hospital, Kyoto ∥Department of Orthopedic Surgery, Osaka Red Cross Hospital ¶Department of Orthopedic Surgery, Kitano Hospital, Osaka #Department of Orthopedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kimura
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Fujibayashi
authors.forename: Bungo
authors.initials: B
authors.lastname: Otsuki
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takemoto
authors.forename: Jitsuhiko
authors.initials: J
authors.lastname: Shikata
authors.forename: Seiichi
authors.initials: S
authors.lastname: Odate
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Matsushita
authors.forename: Akira
authors.initials: A
authors.lastname: Kusuba
authors.forename: Youngwoo
authors.initials: Y
authors.lastname: Kim
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.forename: Masato
authors.initials: M
authors.lastname: Ota
authors.forename: Masanori
authors.initials: M
authors.lastname: Izeki
authors.forename: Naoya
authors.initials: N
authors.lastname: Tsubouchi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010027:Osteotomy; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D065289:Pedicle Screws; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion; D017211:Treatment Failure