Introduction: Degenerative spondylosis, scoliosis and cervical deformity are increasingly recognized entities in patients with Parkinson’s disease. Surgical treatment with spinal decompression and/or fusion can be complicated due to poor bone quality and severe muscular dysfunction in this patient population. There is limited information in the literature regarding outcomes of spine surgery in this population. The purpose of this study was to evaluate the current literature on spine surgery outcomes and complications in patients with Parkinson's disease who undergo spine surgery.
Methods: We performed a literature review using the PubMed and Google Scholar search engines investigating “Parkinson’s disease and spinal surgery” covering the period from 2000-2013. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed.
Results: A total of 95 patients with Parkinson’s disease who underwent spinal surgery were reviewed. The average patient age was 69 with a male to female ratio of 3:4. Average follow up was 40 months (range 14.2 – 66.8). 46 of 73 patients (63%) were judged to have satisfactory outcomes. Poor outcomes were noted in the remaining 37% and included but were not limited to pseudoarthrosis, hardware failure/pullout, persistent kyphosis or sagittal imbalance, and no improvement or worsening in their postoperative visual analog pain scale. Out of this subset of unsatisfactory outcomes, 29 of 65 patients (45%) required revisions. For patients undergoing fusion procedures, 55 of 78 (71%) had successful fusion following the index procedure. Complications following index surgery were reported in 30 of 51(59%) of patients. In patients who underwent decompression surgery only, 6 of 6 (100%) worsened post-operatively necessitating a revision multi-level instrumented fusion.
Conclusions: Patient’s with Parkinson’s disease who undergo spinal surgery appear to have high complication and revision rates with poor outcomes and low fusion rates. It remains unclear whether Parkinson’s patients benefit from spinal surgery for spinal cord decompression, spinal stabilization and correction of spinal deformities. Further prospective studies are warranted to investigate surgical outcomes in this subset of patients.
Patient Care: Increase awarness of outcomes in this patient population
Learning Objectives: 1) awarness of spine surgery outcomes in patients with PD