Surgery for Degenerative Spinal Pathologies in Parkinson's Patients: Low Surgical Benefits for High Risks

Lumbar disc herniation, canal stenosis, and cervicarthrosis are degenerative spinal pathologies frequently observed in the aging population of patients with Parkinson disease (PD). Spinal surgery in PD patients remains risky with uncertain functional results. The main issue is to determine whether a surgical procedure should be performed on PD patients with common degenerative spinal pathologies.

Between 2017 and 2021, 38 PD patients were identified. Data on patient demographics was collected with outcome measures including neurological function, complications, and survival rates.

The median age was 70.7 years, and the median overall survival (OS) time after spinal surgery was 7 years (standard deviation [SD] 0.8). The mean follow-up time was 4.1 years. Thirteen patients (34.2%) died during the follow-up period with a median OS of 3 years. Among the 38 patients operated on: 10 (26.3%) benefited from instrumented surgery (cervicarthrosis or one-level fusion). Instrumented surgery confers a significantly lower median OS: 2.97 years versus 6.99 years for other patients (P = 0.007). The functional results of surgery regardless of type were generally poor: only 17/38 patients (44.7%) improved their walking perimeter and 20 (52.6%) reported that their pain had diminished. The two main prognosis factors with a significant link to better OS were a Hoehn and Yahr Scale ≤4 (P = 0.026), and an American Society of Anesthesiology score ≤2 (P < 0.008).

Noninstrumented or simple fusion level spinal surgery for patients with PD is fraught with numerous complications and produces very poor functional results. Nevertheless, a multidisciplinary perioperative approach for patients, with less invasive surgery whenever possible, provides the necessary conditions to ensure surgical success and avoid aggravating their fragile general condition.