Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P118. Outcomes of patients with Parkinson's disease undergoing cervical spine surgery for radiculopathy and myelopathy with minimum two-year follow-up

Abstract

BACKGROUND CONTEXT Parkinson's disease (PD) is a neuromuscular disorder that affects both mobility and resting tone. This may make patients susceptible to spine malalignment and frequent candidates for surgical interventions. However, there is little evidence comparing the outcomes of PD patients in cervical spinal fusion (CF). PURPOSE This study evaluated the: (1) demographics; (2) complications (medical and surgical); (3) length of stay; (4) hospital charges; (5) reoperations; and (6) readmissions following cervical spine surgery. We hypothesized that patients who have Parkinson's Disease will experience similar postoperative outcomes to other CF patients. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE All patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior or posterior) between 2009 and 2011 and were eligible for at least 2-year follow-up were identified from the New York Statewide Planning and Research Cooperative System (SPARCS). Patients with Parkinson's disease were identified and propensity score matched by age, sex, and DEYO index. A total of 134 propensity score matched patients with and without PD were included. OUTCOME MEASURES Demographic information, complications, length of stay, reoperations, and readmissions. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify all patients with cervical radiculopathy and myelopathy who underwent any cervical spinal fusion (anterior and posterior) from 2009 to 2011 with 2-year follow-up surveillance. Patients with PD were then identified and propensity matched at a 1:1 ratio with patients without PD based on demographics and DEYO index. Demographics, insurance status, and hospital-related parameters were compared between the two groups. Logistic regression was performed to identify any predictive factors for postoperative outcomes. RESULTS There were a total of 134 CF patients included, with 67 patients in the PD group and 67 patients in the nonPD group. PD patients were less commonly white (74.6vs. 91.0%, p=.024) but all other demographics were comparable between the groups. PD patients had significantly longer length of stay (7.3vs. 3.6days, p=.004) and higher total hospital charges ($77,439.13vs. $45,761.24, p=.008) compared to nonPD patients. Overall (41.8vs. 40.3%, p=.861), medical (38.8vs. 31.3%, p=.365) and surgical (11.9vs. 11.9%, p=1) complication rates were comparable between PD and nonPD patients, respectively. However, PD patients did have higher rates of altered mental status (6.0vs. 0%, p=.042) than nonPD patients. PD patients also had comparable reoperation (14.9vs. 13.4, p=.804) and readmission (85.1vs. 74.6%, p=.132) rates as nonPD patients. Regression analysis revealed that Deyo index was the lone significant predictor of higher two-year complication (OR1.936, p .05). CONCLUSIONS This study compared 2-year outcomes between Parkinsonrs Disease and nonPD patients following cervical spinal fusion. PD patients and nonPD patients had comparable rates of complications, reoperations and readmissions at least two years after CF. PD was also not a significant predictor for any adverse outcomes. This study suggested that spine surgeons should not preclude PD patients from undergoing cervical spinal fusion because of a pre-existing PD diagnosis.