title: Quality of life outcomes following cervical decompression for coexisting Parkinson's disease and cervical spondylotic myelopathy.
abstract: Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM.
  
  
  
  The purpose of the present study was to characterize QOL outcomes for patients with coexisting PD and CSM following cervical decompression.
  
  
  
  This is a matched cohort study at a single tertiary-care center.
  
  
  
  Patients with coexisting PD and CSM undergoing cervical decompression between June 2009 and December 2014 were included. These patients were matched to controls with CSM alone by age, gender, American Society of Anesthesiologists classification, Modified Japanese Orthopaedic Association scores, and operative parameters.
  
  
  
  The primary outcome measure was QOL outcomes assessed by change in the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9) at last follow-up (LFU). Change in QOL exceeding the minimal clinically important difference (MCID) was secondary.
  
  
  
  QOL data were collected using the institutional prospectively collected database of patient-reported health status measures. Simple and multivariable regressions were used to assess the impact of PD upon change in QOL.
  
  
  
  Eleven PD patients were matched to 44 controls. Control patients experienced QOL improvement across all three measures, whereas PD patients only improved with respect to PDQ(89.9-80.7, p=.03). Despite no significant differences in preoperative QOL, PD patients experienced poorer QOL at LFU in EQ-5D (0.526 vs. 0.707, p=.01) and PDQ (80.7 vs. 51.4, p=.03), and less frequently achieved an EQ-5D MCID (18% vs. 57%, p=.04). However, no differences in the achievement of an MCID in PDQ or PHQ-9 were observed between cohorts. Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D (β=-0.09, p<.01) and failure to achieve an EQ-5D MCID (odds ratio: 0.08, p<.01).
  
  
  
  This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D.
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA.
authors: Roy
authors: R
authors: Xiao
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA.
authors: Jacob A
authors: JA
authors: Miller
authors: Department of Neurosurgery, Johns Hopkins University, 855 N Wolfe St, Baltimore, MD 21205, USA.
authors: Daniel
authors: D
authors: Lubelski
authors: Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA.
authors: Jay L
authors: JL
authors: Alberts
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
authors: Thomas E
authors: TE
authors: Mroz
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
authors: Edward C
authors: EC
authors: Benzel
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
authors: Ajit A
authors: AA
authors: Krishnaney
authors: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA. Electronic address: machada@ccf.org.
authors: Andre G
authors: AG
authors: Machado
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011788:Quality of Life; D013118:Spinal Cord Diseases / Q000150:complications / Q000601:surgery*; D055009:Spondylosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cervical spondylotic myelopathy; EQ-5D; Minimal clinically important difference; Multivariable regression; PDQ; PHQ-9; Parkinson disease; Quality of life