Resident University of Alabama Birmingham Birmingham, Alabama, United States
Introduction: Parkinson’s Disease (PD) patients are at higher risk of osteoporosis, osteopenia, and paraspinal myopathy. Among PD patients with back pain, approximately one-quarter will have radiologic evidence of lumbar spondylolisthesis. Spinal surgery for PD patients has historically been thought to result in poor outcomes with high complication rates. However, there is a paucity of data and evidence evaluating outcomes following spinal surgery in patients with PD.
Methods: We performed a systematic review using PubMed, Web of Science, and Google Scholar. Articles were included if they were in English and discussed PD patients that underwent spine surgery for thoracolumbar degenerative disease. Articles discussing exclusively thoracolumbar deformity surgery and those using the National Inpatient Sample (due to lack of granular data) were excluded. All surgical techniques (MIS, instrumented open, non-instrumented open) were included.
Results: Nine articles discussing 443 PD patients were included were included in the study; Five studies were cohort studies. Average age was 68±4.3 years, and follow-up time was 28±15.5 months. Two studies reported rates of fusion ranging between 75-86% at the time of latest follow-up. Rates of hardware failure varied between 12.1-33% across five studies. Most studies reported a reoperation rate of approximately one in five patients (21.9-28.8%). The Visual Analogue Scale (VAS) was used in all four studies. In open, instrumented cases, two studies reported that VAS scores improved 1.3 mm in an earlier study, and 50 mm in another study. Two studies on MIS surgery for PD patients reported improvement in VAS by 59.1 and 48.9 points.
Conclusion : This is the first systematic review of surgical and patient-reported outcomes for spine surgery in patients with Parkinson’s disease. There is some evidence for higher likelihood of reoperation, hardware failure, and non-fusion; however, this data does not provide concrete evidence that patients with PD have worse post-operative outcomes following spine surgery. There is only one study in the past 10 years that looks at patient reported outcomes for open, instrumented surgery. Despite reportedly poorer surgical outcomes, PD patients demonstrate improvement on patient-reported outcomes. Further studies are needed to assess these the risk versus benefit for spine surgery in this population.
