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Lumbar Spine Surgery in Patients with Parkinson Disease

Schroeder, Joshua E. MD1; Hughes, Alexander MD2; Sama, Andrew MD2; Weinstein, Joseph MD3; Kaplan, Leon MD1; Cammisa, Frank P. MD2; Girardi, Federico P. MD2

doi: 10.2106/JBJS.N.01049
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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.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Spine 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

2Spine Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021

3Spine Service, Orthopedic Department, Beth Israel Medical Center, 10 Nathan D. Perlman Place, New York, NY 10003

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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