Tremor Impacts Posterior Lumbar Interbody Fusion Outcomes.

Abstract

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