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Galivanche AR, Schneble CA, David WB, Mercier MR, Kammien AJ, Ottesen TD, Saifi C, Whang PG, Grauer JN, Varthi AG. A comparison of in-hospital outcomes after elective anterior cervical discectomy and fusion in cases with and without Parkinson's Disease. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100164. [PMID: 36304443 PMCID: PMC9594612 DOI: 10.1016/j.xnsj.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 01/22/2023]
Abstract
Background Following orthopedic surgery, patients with Parkinson's disease (PD) have been shown to have high rates of surgical complications, and some studies suggest that PD may be associated with greater risk for postoperative medical complications. As complication rates are critical to consider for elective surgery planning, the current study aimed to describe the association of PD with medical complications following anterior cervical discectomy and fusion (ACDF), the most commonly performed procedure to treat cervical degenerative pathology. Methods The 2008-2018 National Inpatient Sample database was queried for cases involving elective ACDF. Demographics and comorbidities were extracted using ICD codes. Cases were propensity matched based on demographic and comorbidity burden, and logistic regression was used to compare in-hospital complications between patients with and without PD. Results After weighting, a total of 1,273,437 elective ACDF cases were identified, of which 3948 (0.31%) involved cases with PD. After 1:1 propensity score matching by demographic and comorbidity variables, there were no differences between the PD and non-PD cohorts. Logistic regression models constructed for the matched and unmatched populations showed that PD cases have greater odds of in-hospital minor adverse events with no differences in odds of serious adverse events or mortality. Conclusions After matching for demographics and comorbidity burden, PD cases undergoing elective ACDF had slightly longer length of stay and greater risk for minor adverse events but had similar rates of serious adverse events and mortality. These findings are important for surgeons and patients to consider when making decisions about surgical intervention.
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Affiliation(s)
- Anoop R. Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Wyatt B. David
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Michael R. Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Taylor D. Ottesen
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Comron Saifi
- Penn Orthopaedics, University of Pennsylvania, 235 S 8th Street, Philadelphia, PA 19107, USA
| | - Peter G. Whang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Arya G. Varthi
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA
- Corresponding author: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510.
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Baucher G, Taskovic J, Troude L, Molliqaj G, Nouri A, Tessitore E. Risk factors for the development of degenerative cervical myelopathy: a review of the literature. Neurosurg Rev 2021; 45:1675-1689. [PMID: 34845577 DOI: 10.1007/s10143-021-01698-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/19/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
Degenerative cervical myelopathy (DCM) encompasses various pathological conditions causing spinal cord (SC) impairment, including spondylosis (multiple level degeneration), degenerative disc disease (DDD), ossification of the posterior longitudinal ligament (OPLL), and ossification of the ligamentum flavum (OLF). It is considered the most common cause of SC dysfunction among the adult population. The degenerative phenomena of DDD, spondylosis, OPLL and OLF, is likely due to both inter-related and distinct factors. Age, cervical alignment, and range of motion, as well as congenital factors such as cervical cord-canal mismatch due to congenital stenosis, Klippel-Feil, Ehler-Danlos, and Down syndromes have been previously reported as potential factors of risk for DCM. The correlation between some comorbidities, such as rheumatoid arthritis and movement disorders (Parkinson disease and cervical dystonia) and DCM, has also been reported; however, the literature remains scare. Other patient-specific factors including smoking, participation in contact sports, regular heavy load carrying on the head, and occupation (e.g. astronauts) have also been suggested as potential risk of myelopathy development. Most of the identified DCM risk factors remain poorly studied however. Further researches will be necessary to strengthen the current knowledge on the subject, especially concerning physical labors in order to identify patients at risk and to develop an effective treatment strategy for preventing this increasing prevalent disorder.
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Affiliation(s)
- Guillaume Baucher
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland.
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin Des Bourrely, 13015, Marseille, France.
| | - Jelena Taskovic
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Lucas Troude
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin Des Bourrely, 13015, Marseille, France
| | - Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
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Umakoshi M, Yasuhara T, Morimoto J, Murai S, Sasaki T, Kameda M, Kin K, Miyoshi Y, Date I. Spinal Surgery after Bilateral Subthalamic Stimulation for Patients with Parkinson's Disease: A Retrospective Outcome Analysis of Pain and Functional Control. Neurol Med Chir (Tokyo) 2021; 61:607-618. [PMID: 34408107 PMCID: PMC8531877 DOI: 10.2176/nmc.oa.2021-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Parkinson’s disease (PD) patients often suffer from spinal diseases requiring surgeries, although the risk of complications is high. There are few reports on outcomes after spinal surgery for PD patients with deep brain stimulation (DBS). The objective of this study was to explore the data on spinal surgery for PD patients with precedent DBS. We evaluated 24 consecutive PD patients with 28 spinal surgeries from 2007 to 2017 who received at least a 2-year follow-up. The characteristics and outcomes of PD patients after spinal surgery were compared to those of 156 non-PD patients with degenerative spinal diseases treated in 2013–2017. Then, the characteristics, outcomes, and spinal alignment of PD patients receiving DBS were analyzed in degenerative spinal/lumbar diseases. The mean age at the time of spinal surgery was 68 years. The Hoehn and Yahr score regarding PD was stage 1 for 8 patients, stage 2 for 2 patients, stage 3 for 8 patients, stage 4 for 10 patients, and stage 5 for 0 patient. The median preoperative L-DOPA equivalent daily dose was 410 mg. Thirteen patients (46%) received precedent subthalamic nucleus (STN) DBS. Lumbar lesions with pain were common, and operation and anesthesia times were long in PD patients. Pain and functional improvement of PD patients persisted for 2 years after surgery with a higher complication rate than for non-PD patients. PD patients with STN DBS maintained better lumbar lordosis for 2 years after spinal surgery. STN DBS significantly maintained spinal alignment with subsequent pain and functional amelioration 2 years after surgery. The outcomes of spinal surgery for PD patients might be favorably affected by thorough treatment for PD including DBS.
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Affiliation(s)
- Michiari Umakoshi
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Jun Morimoto
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Tatsuya Sasaki
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Kyohei Kin
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Yasuyuki Miyoshi
- Department of Neurosurgery, Kawasaki Medical School General Medical Center
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Hollern DA, Shah NV, Moattari CR, Lavian JD, Akil S, Beyer GA, Najjar S, Desai R, Zuchelli DM, Schroeder GD, Passias PG, Hilibrand AS, Vaccaro AR, Schwab FJ, Lafage V, Paulino CB, Diebo BG. Outcomes of Patients With Parkinson Disease Undergoing Cervical Spine Surgery for Radiculopathy and Myelopathy With Minimum 2-Year Follow-up. Clin Spine Surg 2021; 34:E432-E438. [PMID: 34292198 DOI: 10.1097/bsd.0000000000001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort analysis. OBJECTIVE To identify the impact of Parkinson disease (PD) on 2-year postoperative outcomes following cervical spine surgery (CSS). SUMMARY OF BACKGROUND DATA (PD) patients are prone to spine malalignment and surgical interventions, yet little is known regarding outcomes of CSS among PD patients. MATERIALS AND METHODS All patients from the Statewide Planning and Research Cooperative System with cervical radiculopathy or myelopathy who underwent CSS were included; among these, those with PD were identified. PD and non-PD patients (n=64 each) were 1:1 propensity score-matched by age, sex, race, surgical approach, and Deyo-Charlson Comorbidity Index (DCCI). Demographics, hospital-related parameters, and adverse postoperative outcomes were compared between cohorts. Logistic regression identified predictive factors for outcomes. RESULTS Overall, patient demographics were comparable between cohorts, except that DCCI was higher in PD patients (1.28 vs. 0.67, P=0.028). PD patients had lengthier mean hospital stays than non-PD patients (6.4 vs. 4.1 d, P=0.046). PD patients also incurred comparable total hospital expenses ($69,565 vs. $57,388, P=0.248). Individual medical complication rates were comparable between cohorts; though PD patients had higher rates of postoperative altered mental status (4.7% vs. 0%, P=0.08) and acute renal failure (10.9% vs. 3.1%, P=0.084), these differences were not significant. Yet, PD patients experienced higher rates of overall medical complications (35.9% vs. 18.8%, P=0.029). PD patients had comparable rates of individual and overall surgical complications. The PD cohort underwent higher reoperation rates (15.6% vs. 7.8%, P=0.169) compared with non-PD patients, though this difference was not significant. Of note, PD was not a significant predictor of overall 2-year complications (odds ratio=1.57, P=0.268) or reoperations (odds ratio=2.03, P=0.251). CONCLUSION Overall medical complication rates were higher in patients with PD, while individual medical complications as well as surgical complication and reoperation rates after elective CSS were similar in patients with and without PD, though PD patients required longer hospital stays. Importantly, a baseline diagnosis of PD was not significantly associated with adverse two-year medical and surgical complications. This data may improve counseling and risk-stratification for PD patients before CSS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Douglas A Hollern
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Cameron R Moattari
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Joshua D Lavian
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Samuel Akil
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Salem Najjar
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Rohan Desai
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Daniel M Zuchelli
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Frank J Schwab
- Spine Service, Hospital for Special Surgery, New York, NY
| | | | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
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Martini ML, Deutsch BC, Neifert SN, Caridi JM. A National Snapshot Detailing the Impact of Parkinson's Disease on the Cost and Outcome Profiles of Fusion Procedures for Cervical Myelopathy. Neurosurgery 2020; 86:298-308. [PMID: 30957147 DOI: 10.1093/neuros/nyz087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies suggest a higher prevalence of cervical deformities in Parkinson's Disease (PD) patients who predispose to cervical myelopathy (CM). Despite the profound effect of CM on function and quality of life, no study has assessed the influence of PD on costs and outcomes of fusion procedures for CM. OBJECTIVE To conduct the first national-level study that provides a snapshot of the current outcome and cost profiles for different fusion procedures for CM in PD and non-PD populations. METHODS Patients with or without PD who underwent cervical decompression and fusion anteriorly (ACDF), posteriorly (PCDF), or both (Frontback), for CM were identified from the 2013 to 2014 National Inpatient Sample using International Classification of Disease codes. RESULTS A total of 75 870 CM patients were identified, with 535 patients (0.71%) also having PD. Although no difference existed between in-hospital mortality rates, overall complication rates were higher in PD patients (38.32% vs 22.05%; P < .001). PD patients had higher odds of pulmonary (P = .002), circulatory (P = .020), and hematological complications (P = .035). Following ACDFs, PD patients had higher odds of complications (P = .035), extended hospitalization (P = .026), greater total charges (P = .003), and nonhome discharge (P = .006). Although PCDFs and Frontbacks produced higher overall complication rates for both populations than ACDFs, PD status did not affect complication odds for these procedures. CONCLUSION PD may increase risk for certain adverse outcomes depending on procedure type. This study provides data with implications in healthcare delivery, policy, and research regarding a patient population that will grow as our population ages and justifies further investigation in future prospective studies.
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Affiliation(s)
- Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian C Deutsch
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
This article summarizes existing literature examining orthopedic interventions for patients with Parkinson disease (PD). It reviews complications and functional outcomes of shoulder, spine, knee, and hip surgeries in PD. Causes of fall-related fractures in PD and the risk of postoperative cognitive decline after orthopedic interventions in PD are also briefly discussed.
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Affiliation(s)
- Marian Livingston Dale
- Department of Neurology, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: OP32, Portland, OR 97239, USA.
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7
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Zhong H, Zhou Z, Liu J, Guo L, Lv GH, Li J, Zou MX. Letter: Clinical Outcomes Following Surgical Management of Coexisting Parkinson Disease and Cervical Spondylotic Myelopathy. Neurosurgery 2018; 82:E65-E66. [PMID: 29053829 DOI: 10.1093/neuros/nyx540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hua Zhong
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Zhihong Zhou
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Jianchun Liu
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Lebin Guo
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Guo-Hua Lv
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Jing Li
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Ming-Xiang Zou
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
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Reversible Parkinson-Like Symptoms in Patient with Bilateral Chronic Subdural Hematomas and Cervical Spinal Stenosis. World Neurosurg 2018; 109:285-290. [DOI: 10.1016/j.wneu.2017.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/30/2017] [Accepted: 10/03/2017] [Indexed: 11/22/2022]
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