Rates of Subsequent Lumbar Surgery Following Spinal Fusion in Patients With Parkinson Disease: A Propensity-Score Matched Nationwide Cohort Analysis

Abstract

Objective

Parkinson disease (PD) is frequently characterized by a forward-bent posture that increases biomechanical stress on the lumbar spine, which increases the rate of subsequent lumbar surgeries after spinal fusions. This study aimed to evaluate the rates of additional lumbar surgeries following spinal fusion in patients with PD.

Methods

Data from the Health Insurance Review and Assessment Service of the Republic of Korea were retrospectively analyzed. PD was identified using the International Classification of Diseases, 10th Revision code G20. Patients with PD were matched with those without PD in a 3:1 ratio based on sex, age, and Charlson Comorbidity Index using the greedy nearest neighbor matching method. The primary outcome was the rate of subsequent lumbar surgeries following spinal fusion within the 7-year follow-up period. The timing of these reoperations was also assessed.

Results

A total of 2,287 patients with PD and 6,861 matched patients without PD were included in this study. The prevalence of PD among patients undergoing lumbar fusion surgery remained stable throughout the study period. Patients with PD had 1.6-fold higher odds to undergo reoperation compared with the non-PD cohort. No significant difference was observed in the timing of additional surgeries between the groups.

Conclusion

Patients with PD faced 1.6-fold higher odds of subsequent lumbar surgeries following spinal fusion compared to those without the disease. This finding suggests the need for a cautious treatment approach and thorough preoperative optimization when considering lumbar fusion in this population.

INTRODUCTION

Parkinson disease (PD) is characterized by bradykinesia, resting tremors, rigidity, postural instability, and gait disturbances and is the second most prevalent neurodegenerative disorder. Currently, it affects approximately 6 million individuals worldwide, with projections estimating an increase to nearly 13 million by 2040 [1,2]. Despite its noninfectious nature, the term “Parkinson pandemic” has been coined to describe its rapidly escalating global prevalence [1-3].

Lumbar back pain (LBP) is another pervasive condition that is prevalent not only in the general population but also among those with PD, which significantly impairs daily functioning and contributes to disability [4]. Although most LBP cases can be managed by nonsurgical conservative treatments or simple decompressive procedures, some patients require lumbar spinal fusion surgery [5]. With the aging population and increasing incidence of PD, the number of individuals with PD undergoing lumbar spinal fusion surgeries is also increasing. However, these patients are at an increased risk for surgical complications (e.g., implant failures), which may necessitate additional lumbar surgeries because of their unique clinical conditions [5].

Patients with PD are at a higher risk of comorbidities that can negatively impact the outcomes of lumbar fusion surgeries. The elevated prevalence of osteoporosis in this population further complicates the postoperative course [6-8]. Moreover, these patients typically exhibit a characteristic forward-leaning posture associated with paravertebral muscle atrophy and significant sagittal imbalance [9,10]. This predisposes patients to falls and subsequent vertebral fractures. Consequently, an interdisciplinary approach is needed to manage LBP in PD, with a thorough understanding of the disease’s natural history, particularly when considering lumbar fusion [11,12].

Although several studies have investigated the factors associated with revision lumbar surgery in the general population, there is a dearth of research specifically focusing on subsequent lumbar surgeries following lumbar fusion in patients with PD. The existing literature primarily comprises single-center studies or nonmatched cohort analyses, which often yields inconsistent results. This reflects the relative scarcity of lumbar fusion surgeries in the PD population [11]. Therefore, large-scale cohort data are needed to provide more generalized outcomes. Consequently, we aimed to evaluate the prevalence of lumbar fusion surgery and the subsequent lumbar surgery rates in patients with PD in the present study. In addition, propensity-score matched nationwide population data were used to derive more robust and generalizable conclusions.

MATERIALS AND METHODS

1. Data Collection

The Health Insurance Review and Assessment Service (HIRA) of the Republic of Korea (ROK) is the governmental body that is responsible for evaluating and overseeing the healthcare data submitted by the Korean National Health Insurance (KNHI). The HIRA ensures that clinical practices across healthcare facilities in the ROK adhere to established standards and guidelines. It plays an important role in determining reimbursement levels for healthcare providers and monitoring the quality of medical services nationwide. This study was performed after obtaining approval of the institutional review board, which waived the need for informed consent.

The KNHI provides near-universal coverage for citizens of the ROK, resulting in a comprehensive and inclusive database that captures the full spectrum of the nation’s medical activities. This database includes detailed records on diagnoses, prescriptions, treatments, and surgical procedures. Diagnostic coding within this database is based on the International Classification of Diseases, 10th Revision (ICD-10), whereas prescription and procedural coding follow the established protocols of the HIRA (Table 1).

Table 1.

ICD-10 codes and EDI codes for surgical procedures

Classification	Codes	Weights*
Lumbar spinal fusion (index operation)	N0466, N1466, N1460, N2470, N0469, and N1469	N/A
Reoperations	N0303, N0444, N0445, N0446, N0447, N0453, N0466, N0469, N1460, N1466, N1469, N1493, N1494, N1499, N2470, and N2499	N/A
Parkinson disease	G20	N/A
Charlson Comorbidity Index
Myocardial infarction	I21.x, I22.x, and I25.2	0
Congestive heart failure	I09.9, I11.0, I13.0, I13.2, I25.5, I42.0, I42.5–I42.9, I43.x, I50.x, and P29.0	2
Peripheral vascular disease	I70.x, I71.x, I73.1, I73.8, I73.9, I77.1, I79.0, I79.2, K55.1, K55.8, K55.9, Z95.8, and Z95.9	0
Cerebrovascular disease	G45.x, G46.x, H34.0, 160.x–169.x, F05.1, G30.x, and G31.1	0
Dementia	F00.x–F03.x F05.1, G30.x, and G31.1	2
Chronic pulmonary disease	127.8, 127.9, J40.x–J47.x, J60.x–J67.x, J68.4, J70.1, and J70.3	1
Rheumatologic disease	M05.x, M06.x, M31.5, M32.x–M34.x, M35.1, M35.3, and M36.0	1
Peptic ulcer disease	K25.x–K28.x	0
Mild liver disease	B18.x, K70.0–K70.3, K70.9, K71.3–K71.5, K71.7, K73.x, K74.x, K76.0, K76.2–K76.4, K76.8, K76.9, and Z94.4	2
Diabetes without chronic complications	E10.0, E10.1, E10.6, E10.8, E10.9, E11.0, E11.1, E11.6, E11.8, E11.9, E12.0, E12.1, E12.6, E12.8, E12.9, E13.0, E13.1, E13.6, E13.8, E13.9, E14.0, E14.1, E14.6, E14.8, and E14.9	0
Diabetes with chronic complications	E10.2–E10.5, E10.7, E11.2–E11.5, E11.7, E12.2–E12.5, E12.7, E13.2–E13.5, E13.7, E14.2–E14.5, and E14.7	1
Hemiplegia or paraplegia	G04.1, G11.4, G80.1, G80.2, G81.x, G82.x, G83.0–G83.4, and G83.9	2
Renal disease	I12.0, I13.1, N03.2–N03.7, N05.2–N05.7, N18.x, N19.x, N25.0, Z49.0–Z49.2, Z94.0, and Z99.2	1
Any malignancy including leukemia and lymphoma	C00.x–C26.x, C30.x–C34.x, C37.x–C41.x, C43.x, C45.x–C58.x, C60.x–C76.x, C81. x–C85.x, C88.x, and C90.x–C97.x	2
Moderate or severe liver disease	I85.0, I85.9, I86.4, I98.2, K70.4, K71.1, K72.1, K72.9, K76.5, K76.6, and K76.7	4
Metastatic solid tumor	C77.x–C80.x	6
AIDS	B20.x–B22.x and B24.x	4

ICD-10, International Classification of Diseases, 10th Revision; EDI, electronic data interchange; N/A, not applicable; AIDS, acquired immune deficiency syndrome.

^*Weights assigned to calculate the Charlson Comorbidity Index.

This study was performed after obtaining approval of the institutional review board of Korea University Guro Hospital, Korea University College of Medicine (IRB No. 2024GR0114), which waived the need for informed consent.

2. Study Population and Design

In this retrospective cohort study, the medical records of individuals aged 19 years and older who underwent lumbar spinal fusion surgery in the ROK between January 2010 and December 2013 were analyzed. The surgeries were identified using specific procedural codes (i.e., N0466, N1466, N1460, N2470, N0469, and N1469), as documented in the comprehensive nationwide cohort database maintained by the HIRA, which include arthrodesis of lumbar spine—both anterior and posterior techniques with or without interbody fusion. However, the codes do not specify the number of levels operated nor specify the operated segment. Patients who died during the follow-up period were excluded from the analysis. Moreover, lumbar pathologies that were not classified under the relevant “M” codes, such as trauma, malignancies were excluded. (Fig. 1; Table 1).

Fig. 1.

Subject enrollment flowchart. PD, Parkinson disease.

*Adjusted for age, sex, and Charlson Comorbidity Index.

The study population was divided into 2 cohorts: patients who were diagnosed with PD, identified by the ICD-10 code G20, and a comparison group without PD. These cohorts were retrospectively followed for 7 years to monitor subsequent lumbar spine operations. The following electronic data interchange (EDI) codes were used to identify subsequent lumbar surgeries: N0303, N0444, N0445, N0446, N0447, N0453, N0466, N0469, N1460, N1466, N1469, N1493, N1494, N1499, N2470, and N2499. These codes encompass spinal deformity arthrodesis (anterior and/or posterior approaches); lumbar spinal arthrodesis, including both anterior and posterior techniques with or without interbody fusion; osteotomy; lumbar vertebral corpectomy; lumbar laminectomy; and lumbar discectomy, including endoscopic procedures. Subsequent lumbar spine surgical procedure were captured by the above EDI codes, irrespective of whether it was performed at the index fusion level, an adjacent segment, or a nonadjacent lumbar level. This reflects the inherent limitation of administrative coding, not implying revision of the index procedure. Subsequent lumbar surgeries were categorized as “early” and “late” if they occurred within the first 6 months postsurgery and after 6 months, respectively. Separate analyses were performed for each of these timeframes. The 6-month threshold was chosen to capture both acute perioperative complications and subacute mechanical failures (e.g., early proximal junctional failure or symptomatic instability) that often requires improved clinical decision making [13,14].

3. Propensity Score Matching

Confounding variables are often encountered in nationwide observational studies. PD primarily affects the elderly and is more common in men than in women, whereas lumbar fusion surgery is performed across a wider age range and is more frequent in women than in men [15,16]. Severe comorbidities, including metastatic malignancies, may preclude subsequent surgeries because of premorbid conditions. The Charlson Comorbidity Index (CCI) predicts mortality on the basis of weighted comorbidities [17]. In the present study, the propensity scores were de-rived from age, sex, and CCI. Patients with PD were matched with non-PD counterparts using a 1-to-3 greedy nearest neighbor matching method with a caliper width of 0.2 standard deviations of the logit of the propensity score. Covariate balance after matching was assessed using standardized mean differences (SMDs). Age and sex were precisely balanced between groups (SMD=0 for both), and the overall CCI was well balanced (non-PD: 1.74±1.70 vs. PD: 1.80±1.82; SMD<0.1), meeting the conventional threshold for adequate balance. As comorbidities such as malignancies, liver disease, and hemiplegia/paraplegia received higher weights in the updated CCI [17], they were prioritized in the propensity score matching process, thereby enhancing the likelihood of matching patients with severe comorbidities. The weights that were assigned to each comorbidity for the CCI calculation are detailed in Table 1.

4. Primary Outcome

Initially, an analysis was performed to examine the annual trend in PD prevalence among patients who underwent lumbar spinal fusion surgeries from 2010 to 2013. Following propensity score matching, the subsequent lumbar surgery rates were assessed within each cohort over a 7-year follow-up period. Due to the nature of the HIRA database, all included patients were automatically captured for longitudinal follow-up. Finally, the timing of additional lumbar surgeries was investigated and categorized as early (occurring within 6 months of the index surgery) or late (occurring after 6 months).

5. Statistical Analysis

Continuous variables are presented as the mean±standard deviation, whereas categorical variables are shown as frequencies and equivalent percentages. The PD prevalence in patients undergoing lumbar spinal fusion surgeries was evaluated using the Cochran-Armitage trend test. Fisher exact test was used to compare additional lumbar surgery rates and their timing between groups. Statistical significance was considered at p<0.05. SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was used for data organization and statistical analyses.

RESULTS

1. Study Population and Demographics

A total of 76,445 patients underwent lumbar spinal fusion surgery between 2010 and 2013. Among them, 2,287 patients were diagnosed with PD. The proportion of PD among these patients remained relatively stable throughout the study period (Cochran-Armitage trend test, p=0.075).

After 1:3 propensity score matching, the non-PD and PD cohorts comprised 6,861 and 2,287 patients, respectively. Male patients accounted for 29.47%, and the mean age was 67.80±7.36 years in both cohorts (p=1.00). The CCI was comparable between the non-PD and PD cohorts (1.74±1.70 vs. 1.80±1.82, respectively; p=0.13). Comorbidities with higher weights (e.g., metastatic solid tumors, moderate to severe liver diseases, any malignancy including leukemia and lymphoma, renal disease, congestive heart failure, and myocardial infarction) showed no statistically significant differences between groups after propensity score matching (p=0.691, p=0.811, p=0.339, p=0.760, p=0.459, and p=0.163, respectively). However, comorbidities that were frequently seen in patients with PD (e.g., diabetes mellitus with or without chronic complications, peptic ulcer disease, peripheral disease, and cerebrovascular disease) remained imbalanced between groups (p=0.002, p<0.001, p=0.017, and p<0.001, respectively). Dementia also showed a significant difference between groups, although it was weighted as 2 (p<0.01) (refer to Tables 2 and 3).

Table 2.

Charlson Comorbidity Index after propensity score matching

Variable	Non-PD	PD	p-value
Myocardial infarction	95 (1.38)	41 (1.79)	0.163
Congestive heart failure	566 (8.25)	200 (8.75)	0.459
Peripheral vascular disease	1,755 (25.58)	643 (28.12)	0.017*
Cerebrovascular disease	1,004 (14.63)	564 (24.66)	< 0.001*
Dementia	336 (4.90)	235 (10.28)	< 0.001*
Chronic pulmonary disease	2,636 (38.42)	800 (34.98)	0.003*
Rheumatologic disease	783 (11.41)	263 (11.50)	0.909
Peptic ulcer disease	2,862 (41.71)	1,050 (45.91)	< 0.001*
Mild liver disease	2,215 (32.28)	686 (30.00)	0.042*
Diabetes without chronic complications	2,173 (31.67)	803 (35.11)	0.002*
Diabetes with chronic complications	1,016 (14.81)	400 (17.49)	0.002*
Hemiplegia or paraplegia	90 (1.31)	44 (1.92)	0.035*
Renal disease	136 (1.98)	43 (1.88)	0.760
Any malignancy including leukemia and lymphoma	340 (4.96)	102 (4.46)	0.339
Moderate or severe liver disease	39 (0.57)	14 (0.61)	0.811
Metastatic solid tumor	15 (0.22)	4 (0.17)	0.691
AIDS	0 (0)	0 (0)	-

Values are presented as number (%).

PD, Parkinson disease; AIDS, acquired immune deficiency syndrome.

^*p<0.05, statistically significant difference between groups.

Table 3.

Propensity score matching results

Variable	Non-PD (n = 6,861)	PD (n = 2,287)	p-value
Male sex	2,022 (29.47)	674 (29.47)	1.000
Age (yr)	67.80 ± 7.36	67.80 ± 7.36	1.000
CCI	1.74 ± 1.70	1.80 ± 1.82	0.130

Values are presented as number (%) or mean±standard deviation.

PD, Parkinson disease; CCI, Charlson Comorbidity Index.

2. Annual Trend of PD Prevalence in Patients Who Underwent Lumbar Spinal Fusion Surgery

In 2010, the PD prevalence among patients who underwent lumbar spinal fusion surgery was 2.99%, which peaked at 3.19% in 2011 before reaching 2.70% by 2013. However, it did not reach statistical significance (p=0.075) (Fig. 2).

Fig. 2.

Prevalence rate of reoperation after lumbar spinal fusion surgery. No significant up- or downward trend was observed. Pr, probability.

3. Subsequent Lumbar Surgeries and the Timing

Among the cohorts, 792 out of 6,861 patients without PD (11.54%) and 396 out of 2,287 patients with PD (17.31%) underwent subsequent lumbar surgeries within the seven-year follow-up period (Table 4; Fig. 3). The odds of requiring another lumbar surgery were 1.6-fold higher in patients with PD compared to those without PD (odds ratio [OR], 1.605; 95% confidence interval [CI], 1.407–1.830; p<0.001).

Table 4.

Rates and timing of reoperations

Variable	Non-PD (N = 6,861)	PD (N = 2,287)	OR (95% CI)	p-value
Reoperations	792 (11.54)	396 (17.31)	1.61 (1.41–1.83)	< 0.01*
Within 6 months†	95 (1.38)	50 (2.19)	1.60 (1.13–2.26)	< 0.01*
After 6 months	697 (10.16)	346 (15.13)	1.58 (1.38–1.82)	< 0.01*
Time to reoperation (day)	1,145.4 ± 768.2	1,106.6 ± 794.7	-	0.41

PD, Parkinson disease; OR, odds ratio; CI, confidence interval.

^*p<0.05, statistically significant difference between groups.

^†In the subset of patients requiring reoperation, the incidence of reoperations within 6 months did not differ significantly between the 2 cohorts (p=0.833).

Fig. 3.

Prevalence rate of subsequent surgeries after lumbar spinal fusion surgery. The PD cohort has a significantly higher subsequent surgery rate than the non-PD cohort. PD, Parkinson disease. *p<0.05, statistically significant difference between groups.

Out of the 792 additional lumbar surgeries in the non-PD cohort, 95 reoperations (11.99%) occurred within 6 months of the index surgery compared with 50 out of 396 (12.63%) in the PD cohort. Among patients who underwent additional lumbar surgery, early reoperation (within 6 months of the index surgery) occurred in 95 of 792 patients (11.99%) in the non-PD cohort and 50 of 396 patients (12.63%) in the PD cohort. The proportion of early reoperations among all reoperations did not differ significantly between the 2 cohorts (p=0.833) (Table 4; Figs. 3 and 4).

Fig. 4.

Rate of subsequent lumbar surgery. The timing of subsequent lumbar surgery does not differ between the 2 groups. PD, Parkinson disease; ns, not significant.

DISCUSSION

Driven by the aging population, the global incidence of PD is rising and is projected to double by 2040 [2,3]. In parallel with increasing PD cases, there has been a notable increase in the number of lumbar spinal fusion surgeries performed on patients with PD worldwide, which presents unique challenges and considerations for surgical management [18]. However, compared with this global trend, our analysis of the South Korean population cohort from 2010 to 2013 did not demonstrate a significant increasing trend in PD prevalence among patients undergoing lumbar spinal fusion. Although the trend assessment is limited by the relatively short study period (4 years), the prevalence rate in South Korea (ranging from 2.70% to 3.19%) is significantly higher than that reported in the Nationwide Inpatient Sample database in the United States from 2002 to 2011, where the prevalence remained below 1% despite an upward trend [19]. Considering the higher frequency of complications following lumbar spinal fusion procedures in patients with PD, this discrepancy in prevalence rates between South Korea and other regions warrants further investigation. The increased prevalence observed in South Korea highlights the need for careful consideration in managing lumbar spinal fusion in patients with PD.

The primary objective of the present study was to assess the rate of subsequent lumbar surgeries following lumbar spinal fusion surgeries in patients with PD and to compare this rate with those in the general population. To achieve this, nationwide population data were utilized, as reimbursement for PD-specific medications within the KNHI system is contingent upon the accurate entry of the G20 diagnostic code. Propensity score matching techniques were applied to ensure an accurate comparison of rates of subsequent lumbar surgeries among eligible candidates. After the propensity score matching process, the 2 groups were precisely matched for age and sex. Comorbidities with higher CCI weights, including malignancies, moderate or severe liver disease, and renal disease, which are less specific to patients with PD, were also matched. However, the CCI subcategories were not entirely matched because of baseline differences in comorbidities among patients with PD (e.g., dementia; diabetes mellitus; cardiovascular, cerebrovascular, and peripheral vascular diseases; and peptic ulcer disease) (Table 2) [20-22].

The primary finding of this study is 1.6-fold higher odds of additional lumbar surgery in patients with PD than in those without PD. This significant finding highlights the need for spine surgeons and neurologists to recognize and address the increased risk of subsequent lumbar surgery among patients with PD undergoing fusion surgery. Steinle et al. [23] observed a significantly higher reoperation rate at 12 months for elective lumbar surgery in PD patients (9.0% vs. 4.3%) but no difference within 3 months. However, their data did not separate fusion from simple decompression, which is an important distinction given the high risk of mechanical failure in this population. Similarly, Berreta et al. [24] reported reoperation ORs of 1.37 (1 year) and 1.32 (5 years). While that study addressed different surgical pathology, the results remain consistent with the increased risk profile identified in our cohort.

Patients with PD have an increased risk for major postoperative complications associated with lumbar spinal fusion, including surgical site infections, respiratory complications, pulmonary embolism, stroke, and renal failure [25]. In particular, surgical site infection may be a key factor associated with the increased subsequent lumbar surgery rate as its management often necessitates laminectomy with or without instrumentation removal [26]. These readmissions typically occur in the early postoperative period, with a notable increase in the risk up to 90 days after the initial surgery [27]. The aforementioned risk factors likely contributed to earlier additional surgeries observed among patients with PD in the present study.

This study also observed a substantial increase in subsequent lumbar surgeries during the late postoperative phase. Most later reoperations are attributed to instabilities at the same or adjacent levels and occasionally at distant levels [28]. The risk of additional surgeries because of adjacent segment disease is time-dependent, with a rate of 1.7% at 2 years postoperation, which increases to 9% at 8 years in the general population [29]. The major causes of subsequent surgeries at the index level during the late phase include instrument failure and pseudarthrosis, with most occurring beyond one year postsurgery [30]. The potential risk factors for subsequent surgeries include age, female gender, osteoporosis, and sagittal alignment [31,32]. In the present study, age and gender were matched between groups, leaving osteoporosis, and sagittal alignment as modifiable risk factors. These factors may have some association with PD patients that could contribute to the increased subsequent surgery rate following lumbar fusion. This is supported by several studies, which documented the close relationship between osteoporosis and PD that is multifactorial in nature [8]. Moreover, patients with severe PD often present with camptocormia, which is characterized by marked anteflexion of the thoracolumbar spine [33]. This forwardbent posture shifts the gravity line anteriorly, which places increased mechanical stress on the lumbar spine [34]. Such stress can impose a substantial burden on adjacent lumbar segments and instrumented index levels, which may lead to various types of additional surgeries following the initial fusion surgery [28].

The risk factors associated with facet joint conditions and sagittal alignment after fusion surgery greatly depend on operative decisions and techniques, and patient-specific factors. Leaving degenerated hypermobile facets adjacent levels can increase the reoperation risk, and fusion without proper consideration of sagittal balance is also an important risk factor [10,35]. Given the 1.6-fold higher odds of additional surgeries in PD patients following lumbar fusion surgery, aforementioned risk factors should be more carefully examined.

The present study has several limitations primarily because of the nature of national population-based cohort data. First, the dataset does not include information on PD severity, as graded by the Schrag et al. [36] Second, although propensity score matching was used for overall comorbidity scores, not all individual comorbidities within the CCI were perfectly matched. For example, diabetes mellitus, which could significantly affect the subsequent surgery rate because of its association with increased surgical site infections, was not fully controlled. However, the association between PD and diabetes mellitus may be considered a known characteristic of PD [37]. Furthermore, osteoporosis was not directly incorporated as a matching variable or analytic covariate due to the constraints of our data use agreement with HIRA. Given the multifactorial relationship between PD and osteoporosis, this represents a residual confounding limitation that warrants investigation in future studies. However, factors such as fall risk and fractures are largely secondary to PD and its associated comorbidities rather than being independent confounders.; therefore, propensity score matching based on generalized comorbidities may be more appropriate in this study. Furthermore, patients who died during the follow-up period were excluded from the analysis rather than treated as competing events. Given the higher background mortality associated with PD, this exclusion likely resulted in an underestimation of the true subsequent surgery risk difference between groups, suggesting that our findings represent a conservative estimate. Third, the nationwide HIRA data do not provide detailed surgical information, including the specific fusion segment, number of levels fused, surgical approaches used, or individual demographic data for more specific investigations. Consequently, we could not determine whether these additional surgeries occurred at the index level or at distant lumbar levels. Finally, our study utilized a cohort from 2010–2013, a period that precedes the widespread clinical adoption of contemporary interventions such as minimally invasive fusion (minimally invasive spine surgery/lateral lumbar interbody fusions), anabolic osteoporosis agents, and broader Deep Brain Stimulation; consequently, the temporal generalizability of our findings to current surgical and medical practice patterns may be limited. Despite these limitations, the large cohort size in the present study enhances the findings’ generalizability and robustness.

CONCLUSION

Individuals with PD have 1.6 times higher odds of having additional lumbar surgeries compared with those without PD. Considering the growing trend in the global incidence of PD and its relatively high prevalence in the ROK, we anticipate a subsequent increase in the number of lumbar spinal fusion surgeries among patients with PD. Consequently, many patients are expected to require subsequent surgeries. This finding suggests the need for a cautious treatment approach and thorough preoperative optimization when considering lumbar fusion in this population.