Spinal Fusion in Parkinson's Disease Patients

Abstract

Study Design. Retrospective analysis. Objective. To compare outcomes and complication rates between patients with and without Parkinson's disease (PD) patients undergoing surgery for adult spinal deformity (ASD). Summary of Background Data. There is limited literature evaluating the impact of PD on long-term outcomes after thoracolumbar fusion surgery for ASD. Methods. Patients admitted from 2009 to 2011 with diagnoses of ASD who underwent any thoracolumbar fusion procedure with a minimum 2-year follow-up surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. A 1:1 propensity score-match by age, Deyo score, and number of fused vertebral levels was conducted before comparing surgical outcomes of patients with ASD with and without PD. Univariate analysis compared demographics, complications, and subsequent revision. Multivariate binary stepwise logistic regression models identified independent predictors of these outcomes (covariates: age, sex, Deyo Index score, and PD diagnosis). Results. A total of 576 propensity score-matched patients were identified (PD: n = 288; no-PD: n = 288), with a mean age of 69.7 years (PD) and 70.2 years (no-PD). Each cohort had comparable distributions of age, sex, race, insurance provider, Deyo score, and number of levels fused (all P > 0.05). Patients with PD incurred higher total charges across ASD surgery–related visits ($187,807 vs. $126,610, P < 0.001), yet rates of medical complications (35.8% PD vs. 34.0% no-PD, P = 0.662) and revision surgery (12.2% vs. 10.8%, P > 0.05) were comparable. Postoperative mortality rates were comparable between PD and no-PD cohorts (2.8% vs. 1.4%, P = 0.243). Logistic regression identified nine-level or higher spinal fusion as a significant predictor for an increase in total complications (odds ratio = 5.64); PD was not associated with increased odds of any adverse outcomes. Conclusion. Aside from higher hospital charges incurred, patients with PD experienced comparable overall complication and revision rates to a propensity score-matched patient cohort without PD from the general population undergoing thoracolumbar fusion surgery. These results can support management of concerns and postoperative expectations in this patient cohort. Level of Evidence: 3

Patient-specific rods in adult spinal deformity: a systematic review

“…Farah et al had the longest follow-up with an average of 40 months and the highest re-operation rate of ~ 66% (8 of 12). The study included Parkinsonian patients, which is likely associated with this incidence [ 29 , 38 , 39 ].In addition to the profound effects of revisions on patient-wellbeing, revision surgery represents a major portion of the cost-burden in treating ASD patients and increases the average treatment cost by up to 70% [ 40 , 41 ]. Further study of the PSR revision rates is a pre-requisite for an accurate economic comparison to traditional methods of ASD treatment.…”