Cervical Decompression Reduces Pain in Coexistent Parkinson’s Disease and Cervical Spondylotic Myelopathy

Patients with coexistent Parkinson’s disease (PD) and cervical spondylotic myelopathy (CSM) may experience a marked reduction in pain symptoms following cervical decompression, according to results of a matched cohort-controlled retrospective review study presented at the 84th Annual Meeting of the American Association of Neurological Surgeons (AANS).

Parkinson’s disease, however, when isolated as a significant independent predictor of improvement (i.e., reduction in the EuroQol 5-Dimensions [EQ-5D]), demonstrates no significant improvement in quality of life (QoL) after decompression.

Myelopathic symptoms may present singularly in PD and CSM, explained presenter and co-author Jacob Miller, BS, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. “It may be difficult to determine whether cervical decompression would be useful for patients presenting with PD who also happen to have cervical spondylosis according to MRI,” he noted.

“This is important,” Miller added, “as patients with Parkinson’s disease may be undergoing unnecessary cervical decompression, and aetiology of their myelopathic symptoms may be unknown.”

Miller and colleagues hypothesised that QoL outcomes with cervical decompression would be inferior among patients with PD and CSM compared with patients who have CSM alone. The researchers assessed this theory by compiling a review of patients with coexistent PD and CSM receiving cervical decompression surgery between January 2009 and December 2014. They measured QoL outcomes in these patients through the EQ-5D questionnaire, Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9).

Eleven patients with PD were matched with 44 control subjects (mean age for both groups: 65 years). Control patients and patients with PD were followed postoperatively for 13.4 and 12.4 months, respectively.

Multivariable regression found PD to be a predictor of reduced improvement in EQ-5D.

Control subjects experienced a significant postoperative improvement in all 3 QoL assessments, while patients with PD experienced improvement on the PDQ only. In all, 18% of patients with PD experienced only a minimal clinically important difference in EQ-5D.

There were no noticeable differences in preoperative QoL measures between the control and PD groups.

“Patients with coexistent diagnoses of PD and CSM alone have poorer QoL outcomes,” Miller verified.

PD may affect the efficacy of decompression biologically, Miller hypothesised; although, it is more likely, he noted, that patients with PD are misdiagnosed with CSM. Perhaps these patients undergo imaging and have cervical spondylosis, and their myelopathic symptoms are attributed to CSM, leading them to undergo spinal decompression, he opined.

[Presentation title: Quality of Life Outcomes Following Surgical Management of Coexistent Parkinson’s Disease and Cervical Spondylotic Myelopathy. Abstract 504]