44. Go big or go home? What to do with Parkinson's patients needing thoracolumbar fusion

• Published in: The spine journal 2024-09, Vol.24 (9), p.S23-S23
• Main Authors: Lindsey, Matthew H, Levy, Hannah A., Allen, Tyler, Pumford, Andrew, Hamouda, Abdelrahman, Kelly, Brian, Girdler, Steven J, Mikula, Anthony Loren, Goh, Brian Chun Kim, Freedman, Brett A., Sebastian, Arjun Simon, Nassr, Ahmad N.
• Format: Article
• Language: English
• ISSN: 1529-9430
• DOI: 10.1016/j.spinee.2024.06.487

Parkinson's disease (PD) is a progressive and debilitating neuromuscular disease. Patients with PD often have concomitant degenerative spinal disorders. Studies have concluded that patients with Parkinson's disease are at increased risk for perioperative medical complications and poor surgical outcomes, such as failure of hardware and reoperation. As such, there is debate about whether a longer or a limited construct is more appropriate. While larger constructs may have the potential to address deformity and degenerative changes, a larger surgery could expose already at-risk patients to greater complications and morbidity. However, limited fusions could result in persistent malalignment and increased risk for adjacent segment disease/reoperation. Furthermore, there is scant evidence on the most appropriate surgical paradigm for treating Parkinson's patients. We set out to compare patients who had short (1-3 level) or long (>3 levels) thoracolumbar fusions to contrast the outcomes between each surgical approach. This retrospective review of single center experience with spinal fusion patients with concomitant Parkinson's disease at the time of spinal surgery. We included adult patients with PD in our database who underwent primary thoracolumbar spinal fusion while excluding infection and oncologic cases. Radiographic outcome measures by CT and X-ray at one-year follow-up from time of surgery, surgical methods data, morbidity and mortality. We extracted demographic information, Parkinson's-specific metrics, in and out of hospital complications, and surgical data. Univariate analysis compared clinical and radiologic outcomes in patients who underwent either short or long fusion constructs. Ninety-two patients were identified after inclusion and exclusion. Of these, 63 (68%) underwent short fusion and 29 (32%) had long fusion constructs. Short fusion constructs were more strongly associated with radiculopathy 51% vs 21% p= 0.01) while extended fusions had a higher indication of spinal deformity (41% vs 10% p= 0.001) or fracture (34% vs 8% p=0.004) and were more likely to have decreased mobility prior to surgery (79.7% vs 53.9%; P