Outcomes after spinal deformity surgery in patients with Parkinson's Disease: a propensity matched analysis

Adult spinal deformity remains a complex challenge with medical and surgical complication rates post-operatively reported to be around 40 %. Patients with Parkinson's Disease (PD) are particularly susceptible to musculoskeletal disease secondary to postural deformity, muscle rigidity, and bradykinesia and have an increased risk of spinal deformity compared to the general population. There is a paucity of literature investigating the outcomes of multi-level spinal deformity surgery in this at-risk population. Patients undergoing multi-level posterior spinal fusion for spinal deformity with a diagnosis of Parkinson's Disease were identified using the PearlDiver database. Patients with PD were propensity-matched in a 1:1 ratio to a control group by age, Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Medical complications and rates of surgical site infection (SSI) were assessed at 90 days. Surgical revision rates were assessed at 2 years. A total of 2776 patients met criteria with 1,388 patients in the PD group and 1,388 in the control group after propensity matching. Patients with PD had a significantly higher rate of surgical revision at 2 years and an increased risk of 90-day medical complications post-operatively. There was no difference in infection rates between groups within 90 days. Patients with Parkinson's Disease undergoing multilevel posterior spinal fusion for spinal deformity correction have an increased risk of medical complications and need for surgical revision compared to age and comorbidity matched controls. Non-operative management should be exhausted prior to surgical treatment and further research is needed to optimize outcomes in this high-risk patient population.