Sagittal alignment changes and postoperative complications after adult spinal deformity surgery in patients with Parkinson's disease: A multi-institutional retrospective study
Parkinson's disease (PD) has been reported to increase the risk of postoperative complications in patients with adult spinal deformity (ASD). However, those reports are limited, and few have made direct comparisons with patients who do not have PD. Methods: We retrospectively reviewed all surgically treated patients with ASD and at least 2 years of follow-up. Among them, 27 had PD (PD(+) group). Clinical data were collected on early and late postoperative complications and revision surgery.
... vision surgery. Radiographic parameters were evaluated before and immediately after surgery and at final follow-up, including sagittal vertical axis (SVA), thoracic kyphosis, lumbar lordosis, sacral slope, and pelvic tilt. From the same database, we also retrieved 206 controls without PD (PD(−) group) matched for age, sex, and body mass index. Results: For early complications, the PD(+) group showed a higher rate of delirium than the PD(−) group. Deep vein thrombosis and pulmonary embolism rates tended to be higher in the PD(+) group. For late complications, the rate of pseudarthrosis was significantly higher in the PD(+) group. Rates of rod failure and revision surgery due to mechanical complications also tended to be higher, but not significantly, in the PD(+) group (p = 0.17, p = 0.13, respectively). SVA at final follow-up and loss of correction in SVA were significantly higher in the PD(+) group. Conclusion: Extra attention should be paid to perioperative complications, especially delirium and thrombosis, in PD patients undergoing surgery for ASD. Furthermore, loss of correction and rate of revision surgery due to mechanical complications were higher in these patients. Background 4 Parkinson's disease (PD) is a neurodegenerative disorder, the main symptoms of which are rigidity, bradykinesia, and gait disorder. With population aging, the number of patients with this age-related disorder is increasing  . In severe cases, PD causes postural disorder, such as anterocollis, Pisa syndrome, and camptocormia    . Reports have shown that these postural abnormalities increase susceptibility to rigid spinal deformities [2, 3] and that patients with PD develop adult spinal deformity (ASD) more frequently than the general population in the same age groups . Recent studies have shown that ASD negatively affects health-related quality of life [7, 8]. Surgical treatment has been shown to provide better health-related quality of life outcomes than non-surgical treatment, especially in patients with severe deformity . However, high complication rates have been reported with revision rates of up to 47%. Surgical complications are generally divided into perioperative and late complications. Perioperative complications include epidural hematoma, deep vein thrombosis (DVT), and pulmonary embolism (PE), which are usually seen during or soon after surgery. Late complications, such as junctional kyphosis, rod fracture, and pseudarthrosis, typically occur more than 1 month after surgery and are mainly caused by continuous mechanical stress. Generally, PD patients are presumed to have a higher risk of surgical complications, especially mechanical complications due to postural instability, a higher risk of falls, and lower bone quality [10-13] However, to date, only a few small case series have investigated complications after surgery for ASD in PD patients     . In addition, risk factors for complications and revision surgery in PD patients have not yet been confirmed. Therefore, we conducted this multicenter study to investigate 234 surgically treated ASD patients with at least 2 years' follow-up. We compared surgical outcomes and radiographic parameters of PD patients with those of non-PD patients matched for age, sex, and body 5 mass index (BMI). We also investigated risk factors for revision surgery in PD patients. Methods This retrospective observational study follows the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. We reviewed 233 ASD patients treated surgically between January, 2009, through December, 2016, at our hospital and related institutions. Institutional review board approval was obtained at each site for the patient enrollment and data collection protocols. Inclusion criteria were age 21 years or older at the time of surgery, follow-up period of at least 2 years, and surgery including posterior instrumentation of 4 spinal levels with sufficient radiographic data. A total of 27 patients with PD were identified. Data on mean PD duration and Hoehn and Yahr (HY) stage were collected. A control group of 206 non-PD patients was retrieved from the same database. Etiologies included degenerative kyphosis/kyphoscoliosis, post lumbar surgery, and previous vertebral fracture. Operative time and intraoperative blood loss were recorded.