THREE-COLUMN OSTEOTOMY WITH COMBINATION OF COMPRESSION HOOK AND PEDICLE SCREW FIXATION FOR ADULT SPINAL DEFORMITY IN PATIENTS WITH PARKINSON'S DISEASE

摘要

Purpose: Surgical treatment for adult spinal deformity (ASD) in patients with Parkinson's disease (PD) is challenging and is associated with a significant risk of postoperative mechanical complications, such as rod breakage, pseudoarthrosis and proximal junctional failure. We herein report the surgical results of three-column osteotomy with pedicle screw fixation combined with compression hook for ASD associated with PD.Methods: We retrospectively investigated four patients with ASD due to PD who underwent three-column osteotomy with posterior instrumentation. The compression hook system placed on the laminae was used for closure of the osteotomy site during surgery and reinforcement of pedicle screw fixation. Surgical outcomes and radiographical parameters were analyzed.Results: Lumbar lordosis was improved from -25° ± 18° preoperatively to 51° ± 7° postoperatively, and 48°± 5° at the final follow-up examination. The sagittal vertical axis was restored from 297 ± 104 mm preoperatively to 41 ± 13 mm postoperatively, and 72 ± 23 mm at the final follow-up examination. The preoperative VAS (88 ± 14 mm) for low back pain was significantly improved at the final follow-up examination (14 ± 28 mm). Walking disturbance due to low back pain was improved in all patients. No patients had mechanical failure (e.g. rod fracture, pseudarthrosis, or junctional failure) after surgery.Conclusion: The use of compression hooks to supplement pedicle screw fixation is beneficial for performing safe osteotomy closure during surgery and preventing postoperative mechanical failures, and may be a useful option when performing three-column osteotomy for ASD associated with PD.