Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：由于相关的虚弱和畸形，帕金森病（PD）患者代表了具有挑战性的脊柱手术候选人。这项研究巩固了有关PD与非PD患者脊柱手术结果的文献。为了评估PD是否会使患者术后预后恶化，这样可以优化治疗方案。
方法：对PubMed/Medline，Embase,和GoogleScholar数据库符合系统评论和荟萃分析（PRISMA）指南的首选报告项目。感兴趣的研究包括接受脊柱器械融合的比较（PD与非PD）队列。对术后临床结果进行整理，并比较队列之间的显著性。根据所进行的不同外科手术对结果进行了进一步分析（颈椎前路椎间盘切除术和融合术（ACDF），胸腰椎或腰椎融合,胸腰椎或腰椎融合无骨质疏松性椎体压缩性骨折（OVCF）患者）。所有统计分析均使用R项目进行统计计算（4.1.2版），p值<0.05被认为具有统计学意义。
结果：总计，在16项研究中纳入了2,323,650名患者。其中,2,308,949（99.37％）是无PD（非PD）的患者，而14,701例（0.63%）患者在手术时患有PD。集体平均年龄为68.23岁（PD：70.14岁，非PD：64.86岁）。相对而言,男性844,641例(PD:4,574;非PD:840,067)和女性959,908例(PD:3,213;非PD:956,695)。总的来说,PD队列中有更多的术后并发症.具体来说,PD患者经历了明显更多的手术部位感染(p=0.01)，与非PD队列相比,翻修手术率增加(p=0.04),静脉血栓栓塞事件增加(p=0.02).在无OVCF患者的胸腰椎/腰椎融合中，与非PD队列相比,PD队列的翻修手术率增加(p<0.01).然而,当包括胸腰椎/腰椎融合术中的OVCF患者时，PD队列的术后并发症明显较高（p=0.01），肺炎（p=0.02），与非PD队列相比，翻修手术（p<0.01）。
结论：尽管还需要更有力的前瞻性研究，这项研究的结果强调了在术后期间需要先进的伤口护理管理，无论是在医院还是在社区，除了由专职医疗专业人员提供全面的多学科护理外，具有在接受脊柱器械融合的PD患者中使用增强术后恢复（ERAS）方案的潜力。
方法：对PubMed/Medline，Embase,和GoogleScholar数据库符合系统评论和荟萃分析（PRISMA）指南的首选报告项目。感兴趣的研究包括接受脊柱器械融合的比较（PD与非PD）队列。对术后临床结果进行整理，并比较队列之间的显著性。根据所进行的不同外科手术对结果进行了进一步分析（颈椎前路椎间盘切除术和融合术（ACDF），胸腰椎或腰椎融合,胸腰椎或腰椎融合无骨质疏松性椎体压缩性骨折（OVCF）患者）。所有统计分析均使用R项目进行统计计算（4.1.2版），p值<0.05被认为具有统计学意义。
结果：总计，在16项研究中纳入了2,323,650名患者。其中,2,308,949（99.37％）是无PD（非PD）的患者，而14,701例（0.63%）患者在手术时患有PD。集体平均年龄为68.23岁（PD：70.14岁，非PD：64.86岁）。相对而言,男性844,641例(PD:4,574;非PD:840,067)和女性959,908例(PD:3,213;非PD:956,695)。总的来说,PD队列中有更多的术后并发症.具体来说,PD患者经历了明显更多的手术部位感染(p=0.01)，与非PD队列相比,翻修手术率增加(p=0.04),静脉血栓栓塞事件增加(p=0.02).在无OVCF患者的胸腰椎/腰椎融合中，与非PD队列相比,PD队列的翻修手术率增加(p<0.01).然而,当包括胸腰椎/腰椎融合术中的OVCF患者时，PD队列的术后并发症明显较高（p=0.01），肺炎（p=0.02），与非PD队列相比，翻修手术（p<0.01）。
结论：尽管还需要更有力的前瞻性研究，这项研究的结果强调了在术后期间需要先进的伤口护理管理，无论是在医院还是在社区，除了由专职医疗专业人员提供全面的多学科护理外，具有在接受脊柱器械融合的PD患者中使用增强术后恢复（ERAS）方案的潜力。
