Issue release date: 08.03.2024

Turkish Neurosurgery 2023 , Vol 33 , Num 3
Sagittal Spinal Deformity in Patients with Idiopathic Normal Pressure Hydrocephalus
Karina A. LENARTOWICZ1,Ryan M. NAYLOR2,Anthony L. MIKULA2,Jonathan GRAFF-RADFORD3,David T. JONES3,Jeremy K. CUTSFORTH-GREGORY3,Neill R GRAFF-RADFORD4,Jeremy L. FOGELSON2,Petrice M. COGSWELL6,Benjamin D. ELDER2
1Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
2Mayo Clinic, Department of Neurological Surgery, Rochester, MN, 55905, USA
3Mayo Clinic, Department of Neurology, Rochester, MN, 55905, USA
4Mayo Clinic, Department of Neurology, Jacksonville, FL, 32224, USA
5Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, 55905, USA
6Mayo Clinic, Department of Radiology, Rochester, MN, 55905, USA
7Mayo Clinic, Department of Biomedical Engineering, Rochester, MN, 55905, USA DOI : 10.5137/1019-5149.JTN.36555-22.3 AIM: To measure the baseline spinopelvic parameters and characterize the sagittal, and coronal plane deformities in patients with idiopathic normal pressure hydrocephalus (iNPH).

MATERIAL and METHODS: We analyzed a series of patients at one academic institution who underwent ventriculoperitoneal shunting for iNPH with pre-shunt standing full length x-rays. The series of patients was enrolled consecutively to minimize selection bias. We quantified comorbid sagittal plane spinal deformity based on the Scoliosis Research Society-Schwab classification system by assessing pelvic incidence and lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sagittal vertical axis (SVA).

RESULTS: Seventeen patients (59% male) were included in this study. Mean (± standard deviation) age was 74 ± 5.3 years with a body mass index (BMI) of 30 ± 4.5 kg/m2. Six patients (35%) had marked sagittal plane spinal deformity by at least one parameter: five (29%) had greater than 20˚ PI-LL mismatch, three (18%) had >9.5 cm SVA, and one (6%) had PT greater than 30˚. Additionally, the thoracic kyphosis exceeded the lumbar lordosis in nine patients (53%).

CONCLUSION: Positive sagittal balance, with thoracic kyphosis exceeding lumbar lordosis, is common in iNPH patients. This may lead to postural instability, especially in patients whose gait does not improve following shunting. These patients may warrant further investigation and workup, including full length standing x-rays. Future studies should assess for improvement in the sagittal plane parameters following shunt placement. Keywords : Idiopathic normal pressure hydrocephalus, Adult spinal deformity, Postural instability, Scoliosis Research Society- Schwab classification, Health-related quality of life

Corresponding author : Benjamin D. ELDER, elder.benjamin@mayo.edu