Differences in clinical and imaging features of low lumbar osteoporotic vertebral collapse in patients with or without Parkinson’s disease: Rapid destructive progression and appearance of a cauda equina sign in Parkinson’s disease patients

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Abstract BackgroundOsteoporosis and Parkinson’s disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common with aging of society. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD) and a higher mechanical failure rate, compared with those with thoracolumbar junction collapse. The aim of this study was to identify differences in clinical and imaging features, and in outcomes of low lumbar OVC with or without PD and to discuss the appropriate treatment for lower lumbar OVC in patients with PD.MethodsThe subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. Clinical symptoms, morphological features of affected vertebrae, neurological status, surgical procedures, and complications were compared in patients with and without PD.ResultsThe main clinical symptoms were radicular leg pain in non-PD cases (68.8%) and a cauda equina sign in PD cases (72.7%). Rapid progression and destructive changes of OVC were seen in patients with PD at 24.5 ± 10.5 days after injury. The morphological features of OVC were flat-type in non-PD cases with old compression fracture at the thoracolumbar lesion, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar YAM, and severe sarcopenia, all of which can affect postoperative instrumentation-related complications. High postoperative complication rates may be due to vertebral fragility and longer fusion surgery. ConclusionsRapid progression and destructive changes of low lumbar OVC may occur in PD patients, and significantly more PD cases have a cauda equina sign and require urgent surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure, especially at an upper adjacent level. Given the progression of PD after surgery, invasive long-fusion surgery should be avoided for single low lumbar OVC. A surgical strategy considering the severities of PD and osteoporosis, and aggressive control of PD before and after surgery are important to prevent complications.

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