SpineNational trends in spinal fusion for cervical spondylotic myelopathy
Introduction
Cervical spondylotic myelopathy is one of the most common spinal disorders treated by spine surgeons [3], [5]. In the present study, we utilized the NIS database to provide population estimates of trends in CSM. We evaluated trends in patient demographics, outcome, complication rates, discharge disposition, and mortality from 1993 to 2002. In addition, we compared overall trends for patients with CSM with those of patients with CSM who underwent spinal fusion.
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Data source
Data were obtained from the NIS, a nationwide database of hospital inpatient stays and the largest all-payer inpatient care database [1]. Patients from 1993 to 2002 who had the diagnosis of CSM (ICD-9, 721.1) were included in the first part of the study to evaluate overall trends for this disorder comparing 1993 to 1997 (period 1) and 1998 to 2002 (period 2). We further studied patients with a diagnosis of CSM, who also underwent spinal fusion surgery (CCS code, 158).
Patient and hospital characteristics
Independent variables such
Results
A total of 58 115 patients were admitted to the hospital with a primary diagnosis of CSM and underwent spinal fusion from 1993 to 2002. Temporal trends in demographic and hospital characteristics for period 1 (1993-1997) and period 2 (1998-2002) are presented in Table 1, Table 2. Approximately two thirds of the total number of patients were treated in period 2. Across both periods 1 and 2, most patients treated for CSM were in the 45- to 64-year age group (49%, 53%), were predominantly women
Discussion
The NIS database provides a valuable opportunity for examining trends in the frequency of procedures and population characteristics for a number of different diagnoses. In the current study, we analyzed trends in CSM from 1993 to 2002. Overall, 138 792 patients were admitted for the treatment of CSM from 1993 to 2002 with an approximately 2-fold increase in annual admissions and a 7-fold increase (0.6-4.1 per 100 000) in the number of patients with CSM who underwent spinal fusions from 1993 to
Conclusions
Although we have shown a 7× increase in the number of cervical spinal fusions performed for CSM, this has been accomplished without an increase in morbidity (10.3%) or mortality (0.6%). Further studies are needed to evaluate multivariate risk-adjusted impact of comparisons of age and comorbidities on mortality and outcome.
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