A retrospective case series.
To clarify the mid-term results of extensive spinal fusion surgery in patients with Parkinson's disease (PD) or atypical Parkinsonism, especially with respect to their activities of daily living (ADL) over time SUMMARY OF BACKGROUND DATA.: Postural disorders associated with PD lead to spinal imbalance and deformity, resulting in significant disabilities. Clinical outcomes of extensive fusion surgeries in patients with PD over a medium-term follow-up period are currently unknown.
Patients with PD who underwent extensive fusion surgery >5 years prior were included. The patients' backgrounds, surgical and radiographic parameters, peri-operative and mechanical complications, and indoor ADL over time were assessed. To assess the activities of severely disabled patients, indoor ADL was classified into four stages: independent; or cane, walker, and wheelchair use.
Twenty-two patients (mean age, 70.6 years) were included. The mean blood loss, duration of surgery, and fusion levels were 2039 mL, 424 minutes, and 11.9 levels, respectively. Sagittal vertical axis improved from 220 mm preoperatively to 95 mm postoperatively. Peri-operative complications were observed in 17 cases (77%). Before surgery, 1, 5, 12, and 4 cases were independent in ADL, T-cane, walker, and wheelchair use, respectively, which improved to 7, 4, 6, and 4, respectively in one year. Revision surgeries were performed in 8 patients (36%) within 3 years of surgery. In the 3-5 years after the surgery, the ADL of 9 patients worsened due to deterioration of PD. Fifteen cases were followed up over 5 years, at which 1, 2, 4, and 7 cases were independent in ADL, cane, walker, and wheelchair use, respectively.
Surgical intervention in PD patients with spinal deformities leads to good short-term outcomes; however, the patients' conditions deteriorated because of complications within 3 years and worsening of PD over 3 years after the surgery.
Level of evidence: