2020 Volume 11 Issue 10 Pages 1252-1258
Introduction: Among individuals with Parkinson's disease, outcomes of spinal surgery are generally poor, and the risk of reoperation is high. We report a case of implant failure early after combined poteroanterior fusion for osteoporotic lumbar vertebral collapse in a patient with severe Parkinson's disease.
Case Report: A 70-year-old man with a 10 year history of Parkinson's disease (Hoehn & Yahl Scale: Stage III) fell in a public bath. Over approximately 6 weeks, the L4 vertebral body collapsed rapidly, and he developed pain in his legs, a drop foot, and incontinence. When he visited our hospital, the L4 vertebral body completely collapsed, and the bone fragment from the posterior wall retropulsed into the spinal canal. To rule out a metastatic spinal tumor or pyogenic spondylitis, we first performed a biopsy of L4 vertebral body and carried out L2-S1 posterior decompression and fusion. After a possibility of a tumor and infection were ruled out, we diagnosed the patient with an osteoporotic vertebral collapse with delayed palsy. Two weeks later he underwent an anterior vertebral body replacement surgery using an expandable cage with a wide plate. However, the back out of the pedicle screws and the cage dislocation occurred soon after surgery. Therefore, fixation was extended up to T6-ilium. The revision surgery effectively stabilized the anterior cage. Due to another fall during rehabilitation, the vertebral body adjacent to the fixation (T5) fractured and caused myelopathy. The fixation was extended again up to C7. At present, 2 years after the last surgery, the L4 bony fusion was completed, and the patient is now able to walk without any assistance.
Conclusion: There is no consensus regarding the appropriate fusion range for osteoporotic vertebral collapse with Parkinson's disease. However, due to the significant bone fragility, a sufficient posterior fusion range had to be established, even for a combined anterior and posterior fusion.
