Spinal deformity surgery in patients with movement disorders: Trade-off between increased complications and improved long-term quality of life

Introduction

Movement disorders are associated with poor outcomes after adult spinal deformity (ASD) surgery. In a cohort of patients undergoing ASD surgery, we sought to: 1) describe the operations performed in patients with movement disorders, 2) compare outcomes between patients with movement disorders vs. without movement disorders in the areas of mechanical complications, reoperations, and patient-reported outcome measures (PROMs).

Methods

A single-institution, retrospective cohort study was performed for patients with a movement disorder undergoing ASD surgery from 2009 to 2021. Inclusion criteria were: ≥ 5-level fusion, spinal deformity, and 2-year follow-up. Postoperative outcomes included mechanical complications, reoperations, and PROMs. A 3–1 propensity matching was performed, based on age, sex, BMI, and prior surgery.

Results

Among 238 patients undergoing ASD surgery, 10 (4.2 %) had a movement disorder. Five (50.0 %) had Parkinson’s Disease and 5 (50.0 %) had Essential Tremor. No significant difference was found in the type of surgery performed between patients with and without movement disorders, including total instrumented levels, three-column osteotomy, and pelvic instrumentation. Patients with movement disorders developed a higher rate of proximal junctional kyphosis and failure (PJK/F) (80.0 % vs. 40.0 %, p = 0.028) without a significant difference in other mechanical complications or reoperations. Patients with movement disorders had better 2-year ODI (20.1 ± 12.5 vs. 36.7 ± 14.3, p = 0.015) and NRS-back pain than patients without movement disorders (2.3 ± 2.5 vs. 5.0 ± 2.4, p = 0.022).

Conclusion

Patients with and without movement disorders undergo similar ASD operations. Despite a two-fold higher PJK/F rate, movement disorder patients reported better disability and pain at 2-years postoperative.