Tremor Impacts Posterior Lumbar Interbody Fusion Outcomes.

Abstract

Study design: We performed a retrospective study of adult patients who underwent posterior lumbar fusion with interbody devices between 2016 and 2019 using the PearlDiver Claims Database.

Objective: This study examined the outcomes of patients who underwent posterior lumbar fusion with comorbid diagnoses of tremor.

Summary of background data: Prior studies have found high rates of spine surgery complications in Parkinson disease (PD) patients. There is a paucity of literature investigating other movement disorders.

Methods: Patient demographics and outcomes, including short-term opioid use (ceased within 90 d after surgery) and long-term opioid use (continued use beyond 365 d) were extracted. Univariate analysis was performed before and after propensity score matching of tremor patients and nontremor patients.

Results: The study included 54,231 nontremor patients, 1265 PD patients, and 2828 tremor patients. Tremor patients had the highest Charlson Comorbidity Index (2.8) and significantly higher long-term opioid use, medical complications (5.0%), emergency room visits (30.5%), 90-day readmissions (7.7%), and revision surgery (5.8%). The PD group had a higher rate of ICU admission (2.0%) and longer mean length of stay (10 d). Propensity score matching of nontremor patients and tremor patients demonstrated higher rates of medical complications (5.0%, P=0.002), revision (7.7%, P=0.001), 90-day admission (7.7%, P=0.007), and emergency room visits (30.5%, P<0.0001) for tremor patients.

Conclusions: Tremor patients may have a higher rate of complications and long-term opioid use after lumbar fusion compared with patients without movement disorders. Tremor is often considered benign; however, this study suggests it is a significant comorbidity impacting multiple spine surgery outcomes.