Tuesday, November 22, 2022

Orthopedic Surgery And Parkinson’s Disease

If You Develop A Tremor

My Parkinsons Story: Pain

Urgent medical care isn’t needed if you’ve had a tremorshaking or tremblingfor some time. But you should discuss the tremor at your next doctor’s appointment.

If a tremor is affecting your daily activities or if it’s a new symptom, see your doctor sooner.

A written description will help your doctor make a correct diagnosis. In writing your description, consider the following questions:

  • Did the tremor start suddenly or gradually?
  • What makes it worse or better?
  • What parts of your body are affected?
  • Have there been any recent changes in the medicines you take or how much you take?

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Being Prepared & Anticipating Problems

Because of the concerns that we will discuss below, it is prudent to have your neurologist speak to your surgeon and anesthesiologist prior to the surgery so he/she can discuss the potential issues that may arise during and after the surgery. It is also very useful to have your neurologist write a letter with all the necessary information so it can be dispersed to other members of the medical team who will be responsible for your day-to-day care after the surgery.

Depending on the type of surgery, there may be more than one option for anesthesia. General anesthesia may not be the only option, and a more localized form of anesthesia may be possible. Local anesthesia typically causes fewer side effects. Discuss what anesthesia options you have with the surgeon and anesthesiologist prior to the surgery.

In addition, if the surgery requires you to stay in the hospital overnight, consider having a family member or friend stay with you. This person can provide a calming presence, helping to prevent agitation or distress. He or she can keep an eye on whether you are taking your own medications correctly and what additional medications you are bring given.

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Surgical Correction Of Kyphosis In Patients With Camptocormia Associated With Parkinsons Disease: A Case Report And Review Of The Literature

  • 1Spine Department, Sichuan Province Orthopedic Hospital, Chengdu, China
  • 2School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China

Background: Camptocormia is a postural deformity that is characterized by a markedly flexed lumbar spine, with symptoms that worsen with walking and standing. Here, we report a case of camptocormia associated with Parkinsons disease.

Case description: A 70-year-old man with a 7-year history of Parkinsons disease presented with a fall injury that caused lower back pain for 3 months and was aggravated for 2 months. He had been diagnosed with a compression fracture after the fall and had undergone percutaneous kyphoplasty at a local hospital. MRI showed non-union of the L1 vertebra and compression fracture of L2. The patient underwent posterior osteotomy, canal decompression, and internal fixation of the T10-L3 intervertebral plate with bone graft fusion. Postoperative examination showed that the lumbar lordosis was corrected and sensation was restored in both lower extremities. However, after 1 month, the fixation was loosened and a correction surgery was performed at our hospital. At the most recent follow-up at 1.5 years, the patient was found to be in good general health and did not complain of lower back discomfort. He was also actively exercising according to the rehabilitation regimen and had resumed social life.

Parkinson’s Disease Plays Havoc With Common Orthopaedic Conditions

LSVT BIG Treatment for Parkinsons Disease

Newswise Although Parkinson’s disease is a neurological disorder, according to an article in the January 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, the disease also increases a person’s risk of experiencing complicated orthopaedic conditions. The author recommends that all Parkinson’s treatment plans include a multidisciplinary approach in order to address additional accompanying musculoskeletal health issues.

According to the author Lee M. Zuckerman, MD, Chief Resident of orthopaedic surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, in Brooklyn, New York, tremors, body rigidity, and problems with movement caused by PD may lead to other secondary, medical issues. One often-noted example relates to the fact that people with Parkinson’s often move and walk less than non-suffers and generally stay indoors. Decreased movement may lead to bone loss, and the reduced exposure to sunlight that generally occurs when patients spend little time outdoors is likely to generate a decrease in vitamin D, which is needed to keep bones strong. This is particularly harmful to Parkinson’s patients, since the combination of decreased bone density and instability from tremors and rigidity caused by PD greatly increase a person’s risk of:”¢Falling”¢Breaking bones”¢Osteoporosis

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Making Changes To Your Home And Lifestyle

  • Modify your activities and your home. For example, simplify your daily activities and change the location of furniture so that you can hold on to something as you move around the house.
  • Eat healthy foods. This includes plenty of fruits, vegetables, grains, cereals, legumes, poultry, fish, lean meats, and low-fat dairy products.
  • Exercise and do physical therapy. They have benefits in both early and advanced stages of the disease.

Parkinsons Disease And Preparing For Surgery

People with Parkinsons disease sometimes face procedures or surgeries due to other medical conditions not related to PD. These could be relatively simple procedures such as a colonoscopy or endoscopy, common surgeries such as cataract removal, gall bladder removal or hernia repair, or more complex surgeries such as open-heart surgery or transplant surgery. I am frequently asked about specific concerns that arise when contemplating surgery for someone with PD.

People with PD, as well as people with other brain disorders, are more prone to side effects from anesthesia as well as negative effects from the stress of the surgery itself. Its important to remember that not everyone is affected in the same way, and this doesnt mean people with PD cannot have the surgeries and procedures they need. It is however important to be educated about what potential problems may arise so that you are as prepared as you can be.

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Diagnosis And Clinical Features

The tremor of Parkinsons disease is seen at rest, oscillates at about 46 Hz, has a characteristic pill rolling quality, and ceases at the onset of movement. The tremor becomes less marked with movement , but may be postural like essential tremor. However, essential tremor may be differentiated as it is autosomal dominant, often improved by alcohol and not associated with other parkinsonian features. Parkinsonian tremor can be brought out by relaxing the patients arm and asking them to count back from 100, subtracting seven each time. Testing fingernose coordination emphasizes that the tremor is present mainly at rest. Rigidity often accompanies the tremor, giving it a cogwheeling feel. The best movements to test are flexionextension at the elbow and wrist. Bradykinesia is a paucity of movement. The movements appear slow and there is a reduction in the amplitude of the finger excursions. In addition to slowness of finger movements, handwriting is affected with micrographia an easily elicitable feature. Facial expression may be affected giving rise to a characteristic, expressionless face. Parkinsonian patients may also demonstrate a variety of primitive reflexes including the glabellar tap sign.

Ayman Abdelaziz Bassiony1* And Saleh Gameel2

Dr. Wolf: Orthopaedic Spinal Surgery & Voxx HPT

*Corresponding author:Received: Accepted:Keywords

Cite this as

Abstract

Backgroud: Patients with Parkinsons disease are at increased risk for falls and associated hip fractures as a result of tremor, rigidity, and postural instability. The available literature is limited and conflicting regarding the optimal surgical treatment and risk for postoperative complications and mortality in this unique patient population. This study question the effectiveness of dual mobility hip arthroplasty in Parkinsons disease patients with proximal femoral fractures.

Patients and methods: Twelve patients with proximal femoral fracture . Cemented dual mobility acetabular components were used in 9 patients and a cementless dual mobility acetabular components was used in 4 patient. Follow up reports on:postoperative complication rates, in-hospital mortality, length of hospital stay, discharge status, mortality rate, recovery of prefracture ambulatory ability, and return to prefracture activities of daily living. The mean age 65 years and the mean follow-up 32 months.

Results: We did not encounter any case of dislocation of the prosthesis. Seven out of 13 patients returned to pre-fracture activities of daily living with the same disability stage while 5 patients had worsening in disability by 1 stage.

Dual mobility THA in the Parkinsonean patients provides both efficacy and stability with good functional results.

Main article text

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Lumbar Spine Surgery In Parkinsons Patients: Good Results

Researchers from New York and Israel have taken on an unusual topiclumbar spine surgery in patients with Parkinsons disease. The investigators, from Hadassah Hebrew University Medical Center in Jerusalem, and Beth Israel Medical Center and Hospital for Special Surgery in New York City, found that Parkinsons patients fared well after undergoing lumbar spine surgery, and experienced a decrease in pain.

According to the study, the team identified 96 patients who underwent lumbar spine surgery between 2002 and 2012. Of these, 72 had spinal stenosis, 17 experienced spondylolisthesis, and 7 suffered from coronal and/or sagittal deformity. The visual analog scale for back pain improved from 7.4 cm preoperatively to 1.8 cm postoperatively. The visual analog scale for lower-limb pain improved from 7.7 cm preoperatively to 2.3 cm postoperatively. The Oswestry Disability Index score dropped from 54.1 points to 17.7 points at the time of the latest follow-up.

Josh Schroeder, M.D., an orthopedic surgeon with Hadassah Hebrew University Medical Center, told OTW, The study was prompted by several patients who suffered from Parkinsons disease. We tried to locate existing data on the topic, but could not find any large study on Parkinsons, despite this being a disease that affects 5% of the elderly population.

Ldopa And Dopamine Agonists

Apomorphine is a shortacting dopamine agonist that is administered subcutaneously, or sometimes sublingually or intranasally. An important sideeffect is nausea and vomiting, but with the concurrent use of domperidone it may be well tolerated. It is particularly useful administered as an infusion to smooth out motor fluctuations or rescue patients from off periods. It is not widely available, as expertise supervising the use of infusion pumps is essential.

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Revision Surgery At Our Hospital

Three months after surgery, the patient complained of lower back pain that worsened when walking upright and turning over. Physical examination revealed that in-surgical incision was well healed, there was localized pressure and percussion pain in the distal fixed vertebrae segment, and the muscle strength of the lower limbs was normal. No pathologic signs were observed. CT scan and radiograph of the spine showed that the L3 vertebral body was loosely fixed internally and the screws had resorbed the surrounding bone .

Two months after initial surgery, the patient underwent deep-brain electrode placement at West China Hospital. Based on the symptoms, imaging findings, and the patients needs, the revision surgery was chosen to be performed. As the original internal fixation had failed and the patient had severe osteoporosis, the original L3 screw used for internal fixation was removed. Additionally, the L35 vertebral body was lengthened and fixed, the L35 vertebral nail tract was reinforced with bone cement, and a Domino joint head device was installed. After revision surgery, physical examination showed that the local pressure pain and percussion pain had been alleviated. Imaging 3 days after revision surgery showed that kyphosis was corrected and the nail rod was not loosened . At the time of discharge, the patient was instructed to continue wearing the brace and continue with active anti-osteoporosis treatment, with regular review of his condition.

Treating Parkinson’s Disease With Rehabilitation

The Stages of Parkinson

Maintaining physical activity is a very important component in the management of Parkinson’s disease and parkinsonism.

The University of Maryland Parkinson’s Disease and Movement Disorders Center is at the forefront of research to increase our understanding of the effects of physical and cognitive training in Parkinson’s disease and developing recommendations for our patients.

Outpatient rehabilitation therapy enhances the lives of people with Parkinson’s disease. A program of physical therapy and occupational therapy can help people learn movement strategies:

  • How to roll over and get out of bed more easily
  • How to rise from a chair or get out of a car

Therapists sometimes suggest simple devices to assist with daily activities, such as:

  • Shower grab bars
  • Shower stools
  • Elevated toilet seats

Occupational therapists and physical therapists have experience finding ways to help people button shirts, cook and generally keep their lives going. They know about special kinds of utensils that help keep food on a spoon or a fork. Even people with serious tremor, slowness or rigidity can use these utensils to feed themselves without making a mess.

In addition to allowing people to enjoy their meals, this kind of therapy helps people maintain their independence and self-respect. Certain forms of speech therapy can also be valuable in improving voice problems.

In This Section:

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Quality Assessment And Risk Of Bias In Included Studies

Outcomes were ascertained from medical records reviews except for Newman et al,19 Jämsen et al20 and Meek et al21 where data were yielded from the interrogation of health registries. The overall quality level based on the Newcastle-Ottawa quality assessment was average however, four studies were adjudicated with 9/9 stars for their methodological rigour . Although outcome reporting among studies was inconsistent, most of them reported medical complications and the type of implant used, whereas mortality was reported by the authors in only five studies.

N/R N/R

Notes. PD, Parkinsons disease THA, total hip arthroplasty NOF, neck of femur TKR, total knee replacement N/R, not reported N/A, not applicable OA, osteoarthritis UKR, uni-compartmental knee replacement.

*Note that nine operations were carried out for NOF.

The articulation of choice varied among the studies , and authors reported the utilization of cemented and cementless components with success.20,23,25,27 In most studies, there was a tendency to opt for a cemented total hip replacement.20,25,27 A cementless dual-mobility bearing surface was also used by some authors to prevent instability.23

Orthopedic Complications Of Parkinson’s Disease

C. Warren Olanow MD, FRCPC

Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA

Department of Neuroscience, Mount Sinai School of Medicine, New York, NY, USA

Robert and John M. Bendheim Parkinson’s Disease Center, Mount Sinai School of Medicine, New York, NY, USA

Fabrizio Stocchi MD, PhD

Parkinson’s Disease and Movement Disorders Research Centre, Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy

Anthony E. Lang MD, FRCPC

Division of Neurology, University of Toronto, Toronto, ON, Canada

Parkinson’s Disease Research, University of Toronto, Toronto, ON, Canada

Movement Disorder Centre, Toronto Western Hospital, Toronto, ON, Canada

This chapter contains sections titled:

Introduction

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

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Improving Your Mood And Memory

  • Talk to someone about depression. If you are feeling sad or depressed, ask a friend or family member for help. If these feelings don’t go away, or if they get worse, talk to your doctor. He or she may be able to suggest someone for you to talk to. Or your doctor may give you medicine that will help.
  • Be aware of dementia. Dementia is common late in Parkinson’s disease. Symptoms may include confusion and memory loss. If you notice that you are confused a lot or have trouble thinking clearly, talk to your doctor. There are medicines that can help dementia in people with Parkinson’s disease.

Medications And Hospital Stays

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If you take your PD drugs at certain times during the day, a hospital stay can make this challenging. The nurses may not give you these drugs at the times you need to take them. This can cause your PD symptoms to worsen.

Talk to your doctors before surgery about how to maintain your drug schedule. Ensure that your drug list and schedule are available to those taking care of you before, during, and after surgery.4,5

You will likely resume your usual drugs after surgery. This is a decision that your doctor will make and let you know when it is safe to do so. Your PD drugs may need to be adjusted after surgery. This is usually short-term and will be determined by your symptoms and what your doctors think is best.

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Initial Surgery At Our Hospital

Based on the observations, imaging findings, and the patients needs, posterior osteotomy, canal decompression, and internal fixation of the T10-L3 intervertebral plate with bone graft fusion was selected as the treatment option. After the surgery, the patient got out of bed with the protection of a brace, and the pain in the lower back was reduced. Additionally, sensation in the lower limbs was normal, and bowel movement was normal too. The surgical incision healed well and met the criteria for first-stage healing. Postoperative lumbar spine radiography and CT showed that the kyphosis was corrected and the nail rod was not loosened . The patient was satisfied with the outcome of the surgery and was discharged from the hospital. He was asked to continue with oral Parkinsons therapy with additional bisphosphonates, calcium, and vitamin D3 for anti-osteoporosis treatment. The patient was instructed to wear a brace during all daily activities.

Figure 3. Imaging features after initial surgery at our hospital. Postoperative 1-week radiograph indicated alleviation of the kyphosis. Postoperative 1-week CT scan indicated good internal screw fixation .

Unfortunately, a follow-up radiograph taken 1 month after surgery showed a loosening of the L3 pedicle screw. The patient was advised to continue anti-osteoporosis treatment and Parkinsons treatment and wear a brace and was counseled in preparation for possible secondary surgery.

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