School of Medicine, University College Dublin, Dublin, Ireland.
National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland.
Eur Spine J. 2024 Sep;33(9):3420-3442. doi: 10.1007/s00586-024-08307-5. Epub 2024 Jun 27.
Parkinson's Disease (PD) patients represent challenging spinal surgery candidates due to associated frailty and deformity. This study consolidates the literature concerning spinal surgery outcomes in PD versus non-PD patients, to evaluate if PD predisposes patients to worse post-operative outcomes, so that treatment protocols can be optimised.
A systematic review and meta-analysis was conducted of PubMed/Medline, Embase, and Google Scholar databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies of interest included comparative (PD versus non-PD) cohorts undergoing spinal instrumented fusions. Post-operative clinical outcomes were collated and compared for significance between cohorts. Further analysis was made on outcomes based on the different surgical procedures performed (Anterior Cervical Discectomy and Fusion (ACDF), Thoracolumbar or Lumbar fusions, Thoracolumbar or Lumbar fusions without Osteoporotic Vertebral Compression fracture (OVCF) patients). All statistical analysis was performed using The R Project for Statistical Computing (version 4.1.2), with a p-value of < 0.05 deemed statistically significant.
In total, 2,323,650 patients were included across 16 studies. Of those, 2,308,949 (99.37%) were patients without PD (non-PD), while 14,701 (0.63%) patients had PD at time of surgery. The collective mean age was 68.23 years (PD: 70.14 years vs non-PD: 64.86 years). Comparatively, there were 844,641 males (PD: 4,574; non-PD: 840,067) and 959,908 females (PD: 3,213; non-PD: 956,695). Overall, there were more post-operative complications in the PD cohort. Specifically, PD patients experienced significantly more surgical site infections (p = 0.01), increased rates of revision surgeries (p = 0.04) and increased venous thromboembolic events (p = 0.02) versus the non-PD cohort. In thoracolumbar/lumbar spinal fusions without OVCF patients, the PD cohort had increased rates of revision surgeries (p < 0.01) in comparison to the non-PD cohort. However, when including OVCF patients in thoracolumbar/lumbar spinal fusions, the PD cohort had significantly higher amounts of postoperative complications (p = 0.01), pneumonia (p = 0.02), and revision surgeries (p < 0.01) when compared to the non-PD cohort.
Although more robust prospective studies are needed, the results of this study highlight the need for advanced wound care management in the postoperative period, both in-hospital and in the community, in addition to comprehensive multidisciplinary care from allied health professionals, with potential for the use of Enhanced Recovery After Surgery (ERAS) protocols in PD patients undergoing spinal instrumented fusions.
帕金森病（PD）患者由于相关的脆弱性和畸形，是具有挑战性的脊柱手术候选者。本研究整合了关于 PD 与非 PD 患者脊柱手术结果的文献，以评估 PD 是否使患者术后结果恶化，从而优化治疗方案。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 PubMed/Medline、Embase 和 Google Scholar 数据库进行了系统评价和荟萃分析。有兴趣的研究包括比较（PD 与非 PD）接受脊柱器械融合的队列。对队列之间的术后临床结果进行了整理和比较。还根据不同的手术程序（颈椎前路椎间盘切除术和融合术（ACDF）、胸腰椎或腰椎融合术、胸腰椎或腰椎融合术无骨质疏松性椎体压缩性骨折（OVCF）患者）对结果进行了进一步分析。所有统计分析均使用 R 项目进行（版本 4.1.2），p 值<0.05 被认为具有统计学意义。
共有 16 项研究纳入了 2323650 名患者。其中，2308949 名（99.37%）为无 PD 患者（非 PD），14701 名（0.63%）患者在手术时患有 PD。总的平均年龄为 68.23 岁（PD：70.14 岁 vs 非 PD：64.86 岁）。相比之下，有 844641 名男性（PD：4574 人；非 PD：840067 人）和 959908 名女性（PD：3213 人；非 PD：956695 人）。总体而言，PD 队列的术后并发症更多。具体来说，PD 患者经历了更多的手术部位感染（p=0.01）、翻修手术的发生率增加（p=0.04）和静脉血栓栓塞事件增加（p=0.02），与非 PD 队列相比。在无 OVCF 的胸腰椎/腰椎脊柱融合术患者中，PD 队列的翻修手术发生率（p<0.01）高于非 PD 队列。然而，当将 OVCF 患者纳入胸腰椎/腰椎脊柱融合术时，与非 PD 队列相比，PD 队列的术后并发症（p=0.01）、肺炎（p=0.02）和翻修手术（p<0.01）的发生率明显更高。
尽管需要更有力的前瞻性研究，但本研究的结果强调了需要在术后期间，无论是在医院内还是在社区，对 PD 患者进行高级伤口护理管理，以及由联合健康专业人员提供全面的多学科护理，并且可能需要使用手术后恢复加速（ERAS）方案。
