PMID- 27496286 OWN - NLM STAT- MEDLINE DCOM- 20170707 LR - 20181202 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 16 IP - 11 DP - 2016 Nov TI - Quality of life outcomes following cervical decompression for coexisting Parkinson's disease and cervical spondylotic myelopathy. PG - 1358-1366 LID - S1529-9430(16)30827-0 [pii] LID - 10.1016/j.spinee.2016.07.530 [doi] AB - BACKGROUND CONTEXT: Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM. PURPOSE: The purpose of the present study was to characterize QOL outcomes for patients with coexisting PD and CSM following cervical decompression. STUDY DESIGN/SETTING: This is a matched cohort study at a single tertiary-care center. PATIENT SAMPLE: Patients with coexisting PD and CSM undergoing cervical decompression between June 2009 and December 2014 were included. These patients were matched to controls with CSM alone by age, gender, American Society of Anesthesiologists classification, Modified Japanese Orthopaedic Association scores, and operative parameters. OUTCOME MEASURES: The primary outcome measure was QOL outcomes assessed by change in the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9) at last follow-up (LFU). Change in QOL exceeding the minimal clinically important difference (MCID) was secondary. METHODS: QOL data were collected using the institutional prospectively collected database of patient-reported health status measures. Simple and multivariable regressions were used to assess the impact of PD upon change in QOL. RESULTS: Eleven PD patients were matched to 44 controls. Control patients experienced QOL improvement across all three measures, whereas PD patients only improved with respect to PDQ(89.9-80.7, p=.03). Despite no significant differences in preoperative QOL, PD patients experienced poorer QOL at LFU in EQ-5D (0.526 vs. 0.707, p=.01) and PDQ (80.7 vs. 51.4, p=.03), and less frequently achieved an EQ-5D MCID (18% vs. 57%, p=.04). However, no differences in the achievement of an MCID in PDQ or PHQ-9 were observed between cohorts. Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D (beta=-0.09, p<.01) and failure to achieve an EQ-5D MCID (odds ratio: 0.08, p<.01). CONCLUSIONS: This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Xiao, Roy AU - Xiao R AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA. FAU - Miller, Jacob A AU - Miller JA AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA. FAU - Lubelski, Daniel AU - Lubelski D AD - Department of Neurosurgery, Johns Hopkins University, 855 N Wolfe St, Baltimore, MD 21205, USA. FAU - Alberts, Jay L AU - Alberts JL AD - Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA. FAU - Mroz, Thomas E AU - Mroz TE AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA. FAU - Benzel, Edward C AU - Benzel EC AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA. FAU - Krishnaney, Ajit A AU - Krishnaney AA AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA. FAU - Machado, Andre G AU - Machado AG AD - Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA. Electronic address: machada@ccf.org. LA - eng PT - Journal Article DEP - 20160802 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Aged MH - Cervical Vertebrae/*surgery MH - Cohort Studies MH - Decompression, Surgical/*adverse effects MH - Female MH - Humans MH - Male MH - Middle Aged MH - Parkinson Disease/*complications MH - *Quality of Life MH - Spinal Cord Diseases/complications/*surgery MH - Spondylosis/complications/*surgery MH - Treatment Outcome OTO - NOTNLM OT - Cervical spondylotic myelopathy OT - EQ-5D OT - Minimal clinically important difference OT - Multivariable regression OT - PDQ OT - PHQ-9 OT - Parkinson disease OT - Quality of life EDAT- 2016/08/09 06:00 MHDA- 2017/07/08 06:00 CRDT- 2016/08/07 06:00 PHST- 2015/12/14 00:00 [received] PHST- 2016/05/13 00:00 [revised] PHST- 2016/07/18 00:00 [accepted] PHST- 2016/08/09 06:00 [pubmed] PHST- 2017/07/08 06:00 [medline] PHST- 2016/08/07 06:00 [entrez] AID - S1529-9430(16)30827-0 [pii] AID - 10.1016/j.spinee.2016.07.530 [doi] PST - ppublish SO - Spine J. 2016 Nov;16(11):1358-1366. doi: 10.1016/j.spinee.2016.07.530. Epub 2016 Aug 2.