Failure of Long Spinal Construct and Pseudarthrosis in a Patient with Parkinson Disease for the Treatment of Degenerative Lumbar Spinal Disorder: Case Report

ABSTRACT

STUDY DESIGN: Case report. OBJECTIVES: We report a case of treated failure spinal construct and pseudarthrosis in a patient with Parkinson's disease. SUMMARY OF LITERATURE REVIEW: There have been no reports about revision surgery due to failure and pseuarthrosis of degenerative lumbar spine disease in patients with Parkinson's disease. MATERIALS AND METHODS: A 55-year-old female who had been diagnosed with Parkinson's disease 4 years ago presented with back pain and radiating pain on both legs. Radiographic assessment showed spinal stenosis from L2 to L5 combined with degenerative spondylolisthesis at L3-4. Posterior decompression, instrumentation, and posterolateral fusion were performed and her symptoms improved. RESULTS: Two years after the operation, she complained of severe back pain without injury. A simple X-ray showed the pull out of bilateral L5 screws, and revision surgery was performed. Three years after the revision, she underwent re-reoperation due to metal failure. The breakage of a unilateral pedicle screw at L5 was found, and her fusion level was extended to S1 with a posterior lumbar interbody fusion with cages and alar screws. Finally, she has not shown any further failure but, a sagittal imbalance and aggravation of pelvic incidence due to Parkinson's disease have been detected. CONCLUSIONS: Spine surgeons always should consider metal failure, pseudarthrosis, and aggravated spinal imbalance caused by natural history in patients with Parkinson's disease.