Komplikationsanalyse von spinalen Eingriffen bei adulten zentralen Bewegungsstörungen und Skoliosen

 

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Zusammenfassung

Hintergrund: Adulte, zentral bedingte Bewegungsstörungen, Fehlhaltungen und Skoliosen können auf verschiedene neurologische Grunderkrankungen wie den Morbus Parkinson, das Pisa-Syndrom oder die segmentale Dystonie zurückzuführen sein. Wichtige klinische Merkmale sind auffallende Fehlhaltungen wie Kamptokormie („bent spine“) oder ein Laterocollis. Die operative Versorgung der Wirbelsäule bei adulten neuromuskulären Skoliosen und Fehlhaltungen stellt hohe Ansprüche an den Chirurgen. Insbesondere die Dekompensation des sagittalen Alignments stellt ein zentrales Problem dar. Der Morbus Parkinson ist mit erheblichen operationsspezifischen und allgemeinen Komplikationen assoziiert. Das Pisa-Syndrom ist eine Entität, die primär einer medikamentösen Therapie bedarf. Ziel der Arbeit ist eine Analyse von Komplikationen bei spinalen Eingriffen in diesem speziellen Patientenkollektiv. Patienten/Material und Methoden: Eine Fallserie mit 10 Kasuistiken operativ behandelter Patienten mit Morbus Parkinson und Pisa-Syndrom wird vorgestellt und diskutiert. Daraus leiten sich Behandlungsempfehlungen ab, die mit einer Übersicht aus der Literatur ergänzt werden. Ergebnisse und Schlussfolgerung: Bereits minimalinvasive, operative Eingriffe bei Patienten mit Morbus Parkinson können zu Instabilitäten von ganzen Abschnitten der Wirbelsäule und zur Dekompensation des sagittalen Alignments führen. Implantatlockerung, Anschlussinstabilität, allgemeine perioperative Komplikationen und progrediente Fehlhaltung durch Krankheitsprogress können katastrophale Behandlungsverläufe nach sich ziehen. Bei notwendigen Instrumentierungen sollte langstreckigen Verfahren mit ventraler Abstützung der Vorzug gegeben werden. In diesem Patientenklientel sollte bei Osteoporose immer die Pedikelschrauben-Zementaugmentation in Erwägung gezogen werden. Essenziell ist eine optimale präoperative Behandlung der Patienten durch fachneurologische Vorbereitung. Die Diagnose Pisa-Syndrom erfordert ebenfalls eine optimierte präoperative Vorbereitung mit fachneurologischer Unterstützung. In vielen Fällen kann sogar eine operative Intervention durch eine medikamentöse Therapie vermieden werden.

Abstract

Background: Adult central movement disorders, malpostures, and scolioses can have their cause in various neurological underlying diseases such as Morbus Parkinson, Pisa syndrome, or segmental dystonia. Important clinical characteristics are marked postural distortions such as camptocormia (bent spine) or laterocollis. In cases of these adult scolioses, surgical spine treatment puts high demands on the surgeon. Surgery in Parkinsonʼs disease, for example, is associated with serious surgery-specific as well as general complications. The more rarely occurring Pisa syndrome is an entity primarily requiring medical therapy. Patients and Methods: A series of ten case reports of patients with Morbus Parkinson and Pisa syndrome who underwent spinal surgery is presented and discussed. From these reports, treatment recommendations have been derived and complemented by references from the literature. An extensive MEDLINE search was performed for this purpose. Results and Conclusion: In patients suffering from Parkinsonʼs disease, even minor surgical interventions can lead to instability of whole spine segments or even the entire spine. Implant loosening, adjacent segment instability, general perioperative complications, and progressive malposture due to disease progress can bring forth disastrous treatment courses. Spinal fixation should be performed long-segmented in combination with ventral stabilisation. Due to osteoporosis, pedicle screw cement augmentation is recommended in this collective. If the diagnosis of Pisa syndrome is established, an optimised preoperative preparation should be initiated in close cooperation with neurologists. In many cases medical therapy is sufficient and surgical interventions can be avoided.

• Literatur

• 1 Aebi M. The adult scoliosis. Eur Spine J 2005; 14: 925-948
  CrossrefPubMedGoogle Scholar
• 2 Invernizzi M, Carda S, Viscontini GS et al. Osteoporosis in Parkinsonʼs disease. Parkinsonism Relat Disord 2009; 15: 339-346
  CrossrefPubMedGoogle Scholar
• 3 Schranz C, Meinck HM. [Primary neurogenic and myogenic disorders of posture]. Orthopade 2004; 33: 583-590
  PubMedGoogle Scholar
• 4 Duvoisin RC, Marsden CD. Note on the scoliosis of Parkinsonism. J Neurol Neurosurg Psychiatry 1975; 38: 787-793
  CrossrefPubMedGoogle Scholar
• 5 Grimes JD, Hassan MN, Trent G et al. Clinical and radiographic features of scoliosis in Parkinsonʼs disease. Adv Neurol 1987; 45: 353-355
  PubMedGoogle Scholar
• 6 Yokochi F. Lateral flexion in Parkinsonʼs disease and Pisa syndrome. J Neurol 2006; 253 (Suppl. 07) S17-S20
  PubMedGoogle Scholar
• 7 Suzuki T, Matsuzaka H. Drug-induced Pisa syndrome (pleurothotonus): epidemiology and management. CNS Drugs 2002; 16: 165-174
  CrossrefPubMedGoogle Scholar
• 8 Ashour R, Jankovic J. Joint and skeletal deformities in Parkinsonʼs disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 2006; 21: 1856-1863
  CrossrefPubMedGoogle Scholar
• 9 Ali GN, Wallace KL, Schwartz R et al. Mechanisms of oral-pharyngeal dysphagia in patients with Parkinsonʼs disease. Gastroenterology 1996; 110: 383-392
  CrossrefPubMedGoogle Scholar
• 10 Singaram C, Ashraf W, Gaumnitz EA et al. Dopaminergic defect of enteric nervous system in Parkinsonʼs disease patients with chronic constipation. Lancet 1995; 346: 861-864
  CrossrefPubMedGoogle Scholar
• 11 Edwards LL, Quigley EM, Harned RK et al. Characterization of swallowing and defecation in Parkinsonʼs disease. Am J Gastroenterol 1994; 89: 15-25
  PubMedGoogle Scholar
• 12 Fujii T, Nakabayashi T, Hashimoto S et al. Successful perioperative management of patients with Parkinsonʼs disease following gastrointestinal surgery: report of three cases. Surg Today 2009; 39: 807-810
  CrossrefPubMedGoogle Scholar
• 13 Muller MC, Juptner U, Wullner U et al. [Parkinsonʼs disease influences the perioperative risk profile in trauma patients]. Z Orthop Unfall 2008; 146: 227-230
  Article in Thieme ConnectPubMedGoogle Scholar
• 14 Doherty KM, van de Warrenburg BP, Peralta MC et al. Postural deformities in Parkinsonʼs disease. Lancet Neurol 2011; 10: 538-549
  CrossrefPubMedGoogle Scholar
• 15 Reichel G, Kirchhofer U, Stenner A. [Camptocormia–segmental dystonia. Proposal of a new definition for an old disease]. Nervenarzt 2001; 72: 281-285
  CrossrefPubMedGoogle Scholar
• 16 Coulter DM, Pillans PI. Fluoxetine and extrapyramidal side effects. Am J Psychiatry 1995; 152: 122-125
  PubMedGoogle Scholar
• 17 Ekbom K, Lindholm H, Ljungberg L. New dystonic syndrome associated with butyrophenone therapy. Z Neurol 1972; 202: 94-103
  CrossrefPubMedGoogle Scholar
• 18 Hung TH, Lee Y, Chang YY et al. Reversible Pisa syndrome induced by clozapine: a case report. Clin Neuropharmacol 2007; 30: 370-372
  CrossrefPubMedGoogle Scholar
• 19 Suzuki T, Hori T, Baba A et al. Effectiveness of anticholinergics and neuroleptic dose reduction on neuroleptic-induced pleurothotonus (the Pisa syndrome). J Clin Psychopharmacol 1999; 19: 277-280
  CrossrefPubMedGoogle Scholar
• 20 Uemura T, Kasai Y, Araki K et al. Pisa syndrome. J Spinal Disord Tech 2008; 21: 455-457
  CrossrefPubMedGoogle Scholar
• 21 Fichtner CG, Pechter BM, Jobe TH. Pisa syndrome mistaken for conversion in an adolescent. Br J Psychiatry 1992; 161: 849-852
  CrossrefPubMedGoogle Scholar
• 22 Kwak YT, Han IW, Baik J et al. Relation between cholinesterase inhibitor and Pisa syndrome. Lancet 2000; 355: 2222
  CrossrefPubMedGoogle Scholar
• 23 Yassa R, Nastase C, Cvejic J et al. The Pisa syndrome (or pleurothotonus): prevalence in a psychogeriatric population. Biol Psychiatry 1991; 29: 942-945
  CrossrefPubMedGoogle Scholar
• 24 Stubner S, Padberg F, Grohmann R et al. Pisa syndrome (pleurothotonus): report of a multicenter drug safety surveillance project. J Clin Psychiatry 2000; 61: 569-574
  CrossrefPubMedGoogle Scholar
• 25 Cannas A, Solla P, Floris G et al. Reversible Pisa syndrome in Parkinsonʼs disease during treatment with pergolide: a case report. Clin Neuropharmacol 2005; 28: 252
  CrossrefPubMedGoogle Scholar
• 26 Rota E, Bergesio G, Dettoni E et al. Pisa syndrome during aripiprazole treatment: a case report. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31: 286-287
  CrossrefPubMedGoogle Scholar
• 27 Cossu G, Melis M, Melis G et al. Reversible Pisa syndrome (pleurothotonus) due to the cholinesterase inhibitor galantamine: case report. Mov Disord 2004; 19: 1243-1244
  CrossrefPubMedGoogle Scholar
• 28 Bhattacharya KF, Giannakikou I, Munroe N et al. Primary anticholinergic-responsive Pisa syndrome. Mov Disord 2000; 15: 1285-1287
  CrossrefPubMedGoogle Scholar
• 29 Gambarin M, Antonini A, Moretto G et al. Pisa syndrome without neuroleptic exposure in a patient with Parkinsonʼs disease: case report. Mov Disord 2006; 21: 270-273
  CrossrefPubMedGoogle Scholar
• 30 Patel S, Tariot PN, Hamill RW. Pisa syndrome without neuroleptic exposure in a patient with dementia of the Alzheimer type. J Geriatr Psychiatry Neurol 1991; 4: 48-51
  CrossrefPubMedGoogle Scholar
• 31 Mercado E, Alman B, Wright JG. Does spinal fusion influence quality of life in neuromuscular scoliosis?. Spine (Phila Pa 1976) 2007; 32 (Suppl. 19) S120-S125
  CrossrefPubMedGoogle Scholar
• 32 Abresch RT, Carter GT, Jensen MP et al. Assessment of pain and health-related quality of life in slowly progressive neuromuscular disease. Am J Hosp Palliat Care 2002; 19: 39-48
  CrossrefPubMedGoogle Scholar
• 33 Babat LB, McLain RF, Bingaman W et al. Spinal surgery in patients with Parkinsonʼs disease: construct failure and progressive deformity. Spine (Phila Pa 1976) 2004; 29: 2006-2012
  CrossrefPubMedGoogle Scholar
• 34 Djaldetti R, Mosberg-Galili R, Sroka H et al. Camptocormia (bent spine) in patients with Parkinsonʼs disease–characterization and possible pathogenesis of an unusual phenomenon. Mov Disord 1999; 14: 443-447
  CrossrefPubMedGoogle Scholar
• 35 Peek AC, Quinn N, Casey AT et al. Thoracolumbar spinal fixation for camptocormia in Parkinsonʼs disease. J Neurol Neurosurg Psychiatry 2009; 80: 1275-1278
  CrossrefPubMedGoogle Scholar
• 36 Umemura A, Oka Y, Ohkita K et al. Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease. J Neurosurg 2010; 112: 1283-1288
  CrossrefPubMedGoogle Scholar