Article
Surgical treatment of camptocormia – indication, technique and results
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Authors
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Kai-Michael Scheufler
- Klinikum Dortmund, Klinik für Neurochirurgie, Dortmund, Deutschland
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Daniela Diesing
- Klinikum Dortmund, Klinik für Neurochirurgie, Dortmund, Deutschland
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Rolf Schultheiß
- Klinikum Dortmund, Klinik für Neurochirurgie, Dortmund, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: 6-10% of patients with Parkinsons disease (PD) are affected by Camptocormia/Pisa syndrome. Surgical management previously has been reported to be fraught with unacceptable complications rates. Furthermore, surgical indication criteria have been ill-defined. This prospective study reports on indication criteria, surgical technique and results of a recent consecutive series of 19 PD patients with camptocormia.
Methods: Perioperative clinical (age, sex, MDS-UPDRS, ODI, SF12-PCS, comorbidity) and radiographic (global and regional balance parameters, spinopelvic morphometry) findings as well as mid-term (12-49mo, mean: 27.5±12mo) clinical outcomes and complication rate were analyzed in 19 individuals (age: 66.7±6.7y) with long-standing PD (duration>10y) and advanced camptocormia/Pisa syndrome (>3y) with trunk extensor atrophy and structural decompensation (partially fixed deformity), surgically treated by instrumented deformity correction including 3-column osteotomies and fusion from T2 to the sacropelvis. Surgery was staged (thoracic/lumbosacropelvic) in 5 patients.
Results: Restoration of age-adjusted physiological sagittal and coronal balance was achieved in all patients. Mean OR time/blood loss was 6.6h/1.8l. Mean ODI and SF12-PCS scores improved significantly in all patients (p: 0.002) and remained stable throughout FU. Improvements in SF12-PCS scores were inversely related to medical comporbidity and preoperative MDS UPDRS part I/II scores. Major complications (rod-breakage, instrumentation failure, infection, neurological compromise) occurred in 5 patients (26%). Perioperative dopaminergic medication adjustments were required in 7 individuals (27%).
Conclusion: Surgical correction of advanced camptocormia/Pisa syndrome by instrumented fusion from T2 to sacropelvis presents an abundance of therapeutic challenges, warrants careful patient selection, meticulous surgical technique, and multidisciplinary perioperative management. However, reasonable surgical morbidity and mid-term clinical results comparable to those generally accepted in adult deformity surgery may be obtained in experienced hands. Careful preoperative patient evaluation and counseling is prerequisite to successful operative management.
