Impact of Deep Brain Stimulation therapy on the vertebral sagittal balance in Parkinson’s disease patients

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Background: Parkinson’s Disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorso-lateral region of STN, on the sagittal balance of patients affected by PD. Patients and Methods Among all patients undergone DBS procedures in our Institution, we selected 8 subjects, 4 female and 4 males, with selective targeting on the dorso-lateral region of the Subthalamic Nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months post-surgery were carried out. Results: Comparison of preoperative and postoperative spine X-ray data showed that patients showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Conclusions: Deep Brain Stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson’s Disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.

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