Lumbar Spine Surgery in Patients with Parkinson Disease.
BACKGROUND
Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have been reported.


METHODS
All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients' charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed.


RESULTS
Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was <2 in thirteen patients, 2 in thirty patients, 2.5 in twenty-three patients, and ≥3 in thirty patients. The primary indication for surgery was spinal stenosis in seventy-two patients, spondylolisthesis in seventeen patients, and coronal and/or sagittal deformity in seven patients. There were nineteen early complications, including postoperative infections requiring surgical irrigation and debridement and long-term antibiotics in ten patients. The visual analog scale for back pain improved from 7.4 cm preoperatively to 1.8 cm postoperatively (p < 0.001). The visual analog scale for lower-limb pain improved from 7.7 cm preoperatively to 2.3 cm postoperatively (p < 0.001). The Oswestry Disability Index score dropped from 54.1 points to 17.7 points at the time of the latest follow-up (p < 0.001). The Short Form-12 Physical Component Summary score improved from 26.6 points preoperatively to 30.5 points postoperatively (p < 0.05). Twenty patients required revision surgery. Risks for further surgery included a Parkinson disease severity stage of ≥3 (p < 0.05), a history of diabetes mellitus, treatment for osteoporosis, and a combined anterior and posterior approach.


CONCLUSIONS
Despite a higher rate of complications than in the general population, the overall outcome of spine surgery in patients with mild to moderate Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted.
Spine Unit, Orthopedic Complex, Hadassah Hebrew University Medical Center, Kiryat Hadasash, POB 12000, Jerusalem, Israel, 91120. E-mail address for J.E. Schroeder: Schroeder.josh@gmail.com.
Joshua E
JE
Schroeder
Spine Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021.
Alexander
A
Hughes
Spine Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021.
Andrew
A
Sama
Spine Service, Orthopedic Department, Beth Israel Medical Center, 10 Nathan D. Perlman Place, New York, NY 10003.
Joseph
J
Weinstein
Spine Unit, Orthopedic Complex, Hadassah Hebrew University Medical Center, Kiryat Hadasash, POB 12000, Jerusalem, Israel, 91120. E-mail address for J.E. Schroeder: Schroeder.josh@gmail.com.
Leon
L
Kaplan
Spine Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021.
Frank P
FP
Cammisa
Spine Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021.
Federico P
FP
Girardi
D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000601:surgery; D012086:Reoperation; D013121:Spinal Curvatures / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D013168:Spondylolisthesis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome