Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Sci Rep. 2021 Jul 9;11(1):14235. doi: 10.1038/s41598-021-93798-1.
Osteoporosis and Parkinson's disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.
骨质疏松症和帕金森病（PD）是与年龄相关的疾病，PD 患者的骨质疏松性椎体压缩骨折（OVC）手术变得越来越常见。OVC 通常影响胸腰椎，但在骨密度（BMD）较低的患者中，低腰椎 OVC 更为常见。本研究旨在确定有或没有 PD 的低腰椎 OVC 的临床和影像学特征差异，并讨论适当的治疗方法。研究对象为 43 例接受手术治疗的 L3 以下低腰椎 OVC 患者，其中 11 例为 PD 患者。主要临床症状为非 PD 患者的神经根痛和 PD 患者的马尾征。PD 患者的 OVC 快速进展和破坏性改变。非 PD 患者的 OVC 形态特征为陈旧性压缩性骨折的扁平型，PD 患者则为无陈旧性压缩性骨折的破坏型。PD 的进展与腰椎前凸减少、低腰椎 BMD 降低和严重的肌肉减少症有关。较高的术后并发症发生率与椎体脆弱和更长的融合手术有关。PD 进展导致的姿势不稳定可能导致机械应力和器械失效。对于单个低腰椎 OVC，应避免进行侵袭性长融合手术。
