Clinical Features & Outcomes After Degenerative Spine Surgery in Patients with Parkinson’s Disease

Introduction: Degenerative spine surgery in Parkinson’s disease (PD) patients may increasingly demand neurosurgical attention as the proportion of elderly grows. Managing these complex cases may require specific considerations. We systematically reviewed the literature on outcomes and complications after degenerative spine surgery in PD patients.

Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched from inception to January 6, 2022, using the PRISMA guidelines to include studies reporting clinical data of patients with PD undergoing degenerative spine surgery. Demographics, clinical characteristics, treatment protocols, and functional and satisfaction outcomes were analyzed.

Results: A total of 22 articles with 442 patients (61.5% female) was included. Mean age was 66.9±3.5 years (range, 41-83 years). Mean PD duration and modified Hoehn & Yahr stage were 4.46±2.39 years and 2.3±0.8, respectively. Operation types included fusion (55.3%) and decompression (41.6%). Mean operated spine levels were 6.0±5.08. A total of 377 postoperative complications occurred in 34.6% patients, categorized into mechanical failure (58.0%), infection (15.1%), or neurologic (10.7%). Surgical revisions were required in 31.8% with an average of 1.88±1.03 revisions per patient. The average normalized pre-surgery, post-surgery, and final aggregate numerical patient outcome scores were respectively 0.37±0.13, 0.63±0.18, and 0.61±0.19, with a score of 0 and 1 representing the worst and best possible score. Minority of patients met post-operative spinopelvic realignment objectives of an SVA < 5 cm (46%), PT < 20 (1%), and LL = PI ±9 (23%).

Conclusion : Although degenerative spine surgery in PD patients may require revision surgeries in nearly a third of patients, appropriately selected patients can benefit from surgical intervention. Surgery should be offered after exhausting all other treatment options and is typically reserved for patients with myelopathy or significant disability, though patient motivation and preference should be considered. Successful outcomes likely depend on strong interdisciplinary support to control the movement disorder before and after surgery.