Neurological Surgery 脳神経外科49巻1号

2021年01月発行

総説

パーキンソン病に伴う脊椎変性疾患の治療

著者： 岩室宏一¹²³ 尾原裕康²³ 梅村淳¹³ 服部信孝¹⁴ 新井一³

所属機関： ¹順天堂大学大学院医学研究科運動障害疾患病態研究・治療講座 ²順天堂大学医学部附属順天堂医院脊椎脊髄センター ³順天堂大学医学部脳神経外科 ⁴順天堂大学医学部脳神経内科

ページ範囲：P.171 - P.184

Ⅰ はじめに
　パーキンソン病（Parkinson's disease：PD）は，かつて「発症後10年で寝たきりになる」と言われ，実際，L-ドパが使われる以前には発症後の平均生存期間は9.4年であり，死亡率も非PD群の約3倍であると報告された^1）．しかし，1970年代に治療薬としてL-ドパが普及し，その後，PD治療はめざましく進歩した．1986年以降の信憑性の高い発端コホート研究^2）に限れば，PDの死亡率は非PD群の約1.5倍という報告が多数である．
　発症後の生命予後が延長した一方で，PDの長期罹患に伴う合併症にどう対処するか，つまり，機能予後をいかに改善するかが新たな課題になっており，その1つが脊椎変性である．その背景には，PDの有無にかかわらず加齢性疾患を発症するということだけではなく，PD症状としての傍脊柱筋の筋緊張異常や姿勢保持障害によって，PDでは非PDとは異なる生体力学的・生理学的作用が脊椎に働いていることがあると考えられる．
　本稿では，PD患者の脊椎変性の特徴を概説し，脊椎外科の観点からみた治療の可能性と限界を考える．

参考文献

1）Hoehn MM, Yahr MD：Parkinsonism：onset, progression and mortality. Neurology 17：427-442, 1967

2）Macleod AD, et al：Mortality in Parkinson's disease：a systematic review and meta-analysis. Mov Disord 29：1615-1622, 2014

3）Pringsheim T, et al：The prevalence of Parkinson's disease：a systematic review and meta-analysis. Mov Disord 29：1583-1590, 2014

4）Xu K, et al：Comorbid conditions in Parkinson's disease：a population-based study of statewide Parkinson's disease registry. Neuroepidemiology 50：7-17, 2018

5）Galazky I, et al：The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson's disease：implications on spinal surgery. Eur Spine J 27：2847-2853, 2018

6）Srivanitchapoom P, Hallett M：Camptocormia in Parkinson's disease：definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry 87：75-85, 2016

7）Tiple D, et al：Camptocormia in Parkinson disease：an epidemiological and clinical study. J Neurol Neurosurg Psychiatry 80：145-148, 2009

8）Tinazzi M, et al；Italian Pisa Syndrome Study Group：Pisa syndrome in Parkinson disease：an observational multicenter Italian study. Neurology 85：1769-1779, 2015

9）Choi HJ, et al：Coronal plane spinal malalignment and Parkinson's disease：prevalence and associations with disease severity. Spine J 15：115-121, 2015

10）Ashour R, Jankovic J：Joint and skeletal deformities in Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 21：1856-1863, 2006

11）Kashihara K, et al：Dropped head syndrome in Parkinson's disease. Mov Disord 21：1213-1216, 2006

12）Revuelta GJ：Anterocollis and camptocormia in parkinsonism：a current assessment. Curr Neurol Neurosci Rep 12：386-391, 2012

13）Ho B, et al：A case of levodopa-responsive camptocormia associated with advanced Parkinson's disease. Nat Clin Pract Neurol 3：526-530, 2007

14）Umemura A, et al：Effect of subthalamic deep brain stimulation on postural abnormality in Parkinson disease. J Neurosurg 112：1283-1288, 2010

15）Fietzek UM, et al：Goal attainment after treatment of parkinsonian camptocormia with botulinum toxin. Mov Disord 24：2027-2028, 2009

16）Furusawa Y, et al：Role of the external oblique muscle in upper camptocormia for patients with Parkinson's disease. Mov Disord 27：802-803, 2012

17）Oyama G, et al：Mechanism and treatment of dropped head syndrome associated with parkinsonism. Parkinsonism Relat Disord 15：181-186, 2009

18）Spuler S, et al：Myopathy causing camptocormia in idiopathic Parkinson's disease：a multidisciplinary approach. Mov Disord 25：552-559, 2010

19）Hemmi S, et al：Dramatic response of dropped head sign to treatment with steroid in Parkinson's disease：report of three cases. Intern Med 50：757-761, 2011

20）Torsney KM, et al：Bone health in Parkinson's disease：a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 85：1159-1166, 2014

21）Kalilani L, et al：Comparing the incidence of falls/fractures in Parkinson's disease patients in the US population. PLoS One 11：e0161689, 2016

22）Purvis TE, et al：Is decompressive surgery for cervical spondylotic myelopathy effective in patients suffering from concomitant multiple sclerosis or Parkinson's disease? Brain Sci 7：39, 2017

23）Broetz D, et al：Radicular and nonradicular back pain in Parkinson's disease：a controlled study. Mov Disord 22：853-856, 2007

24）Kim YE, et al：Musculoskeletal problems in Parkinson's disease：neglected issues. Parkinsonism Relat Disord 19：666-669, 2013

25）Savica R, et al：Parkinsonism and dropped head：dystonia, myopathy or both? Parkinsonism Relat Disord 18：30-34, 2012

26）Tinazzi M, et al：Pisa syndrome in Parkinson's disease：an electrophysiological and imaging study. J Neurol 260：2138-2148, 2013

27）Barrey C, et al：Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22（Suppl 6）：S834-S841, 2013

28）Yokoyama K, et al：Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults. Neurol Res 39：414-418, 2017

29）Barrey C, et al：Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16：1459-1467, 2007

30）Jalai CM, et al：Full-body analysis of age-adjusted alignment in adult spinal deformity patients and lower-limb compensation. Spine（Phila Pa 1976）42：653-661, 2017

31）Asai Y, et al：Sagittal spino-pelvic alignment in adults：The Wakayama Spine Study. PLoS One 12：e0178697, 2017

32）Sasaki T, et al：MRI-defined paraspinal muscle morphology in Japanese population：The Wakayama Spine Study. PLoS One 12：e0187765, 2017

33）Watanabe K, et al：Characteristics of spinopelvic alignment in Parkinson's disease：comparison with adult spinal deformity. J Orthop Sci 22：16-21, 2017

34）Oh JK, et al：Sagittal spinopelvic malalignment in Parkinson disease：prevalence and associations with disease severity. Spine（Phila Pa 1976）39：E833-E841, 2014

35）Geroin C, et al：Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson's disease? An observational cross-sectional study. Parkinsonism Relat Disord 21：736-741, 2015

36）Vaugoyeau M, et al：Proprioceptive impairment and postural orientation control in Parkinson's disease. Hum Mov Sci 30：405-414, 2011

37）Ameghino L, et al：Postural disorders and antiparkinsonian treatments in Parkinson disease：an exploratory case-control study. Clin Neuropharmacol 41：123-128, 2018

38）Mano T：Camptocormia induced by a dopaminergic agonist. Clin Neuropharmacol 41：70-72, 2018

39）Ameghino L, et al：Ropinirole-induced anterocollis in Parkinson's disease. Mov Disord Clin Pract 3：91-92, 2015

40）Suzuki M, et al：Pramipexole-induced antecollis in Parkinson's disease. J Neurol Sci 264：195-197, 2008

41）Taguchi Y, et al：Pramipexole-induced dropped head syndrome in Parkinson's disease. Intern Med 47：2011-2012, 2008

42）Galati S, et al：Ropinirole-induced Pisa syndrome in Parkinson disease. Clin Neuropharmacol 37：58-59, 2014

43）Hanami K, et al：Dopamine D2-like receptor signaling suppresses human osteoclastogenesis. Bone 56：1-8, 2013

44）Nakashioya H, et al：Therapeutic effect of D1-like dopamine receptor antagonist on collagen-induced arthritis of mice. Mod Rheumatol 21：260-266, 2011

45）Babat LB, et al：Spinal surgery in patients with Parkinson's disease：construct failure and progressive deformity. Spine（Phila Pa 1976）29：2006-2012, 2004

46）Koller H, et al：Spinal surgery in patients with Parkinson's disease：experiences with the challenges posed by sagittal imbalance and the Parkinson's spine. Eur Spine J 19：1785-1794, 2010

47）Kimura H, et al：Lumbar spinal surgery in patients with Parkinson disease：a multicenter retrospective study. Clin Spine Surg 30：E809-E818, 2017

48）Baker JF, et al：Management of spinal conditions in patients with Parkinson disease. J Am Acad Orthop Surg 25：e157-e165, 2017

49）Upadhyaya CD, et al：Spinal deformity and Parkinson disease：a treatment algorithm. Neurosurg Focus 28：E5, 2010

50）Ye BK, et al：Correction of camptocormia using a cruciform anterior spinal hyperextension brace and back extensor strengthening exercise in a patient with Parkinson disease. Ann Rehabil Med 39：128-132, 2015

51）Frazzitta G, et al：Pisa syndrome in Parkinson's disease：electromyographic aspects and implications for rehabilitation. Parkinsons Dis 2015：437190, 2015

52）Watanabe K, et al：Surgical outcomes of spinal fusion for osteoporotic thoracolumbar vertebral fractures in patients with Parkinson's disease：what is the impact of Parkinson's disease on surgical outcome? BMC Musculoskelet Disord 20：103, 2019

53）Sarkiss CA, et al：To operate or not?：a literature review of surgical outcomes in 95 patients with Parkinson's disease undergoing spine surgery. Clin Neurol Neurosurg 134：122-125, 2015

54）Bourghli A, et al：Posterior spinal fusion from T2 to the sacrum for the management of major deformities in patients with Parkinson disease：a retrospective review with analysis of complications. J Spinal Disord Tech 25：E53-E60, 2012

55）Fasano A, et al：Treatment of motor and non-motor features of Parkinson's disease with deep brain stimulation. Lancet Neurol 11：429-442, 2012

56）Agari T, Date I：Spinal cord stimulation for the treatment of abnormal posture and gait disorder in patients with Parkinson's disease. Neurol Med Chir（Tokyo）52：470-474, 2012

57）Kapetanakis S, et al：Transforaminal percutaneous endoscopic discectomy for lumbar disc herniation in Parkinson's disease：a case-control study. Asian Spine J 10：671-677, 2016