Elsevier

Surgical Neurology

Volume 71, Issue 1, January 2009, Pages 66-69
Surgical Neurology

Spine
National trends in spinal fusion for cervical spondylotic myelopathy

https://doi.org/10.1016/j.surneu.2008.02.045Get rights and content

Abstract

Background

The objective of this study is to provide a retrospective analysis using an NIS database to examine national trends in outcomes for CSM from 1993 to 2002.

Methods

Data for CSM admissions (n = 138 792) were extracted from the 1993 to 2002 NIS database to determine overall outcomes, as well as for those patients with CSM who underwent spinal fusion. Data from 1993 to 1997 (period 1) were compared with data from 1998 to 2002 (period 2).

Results

The number of patients admitted with CSM increased 2-fold from 3.73 to 7.88 per 100 000 US population. Approximately 10% of patients were admitted from the ED and 42% underwent spinal fusion. The number of patients with CSM that underwent spinal fusion increased 7-fold from 0.6 to 4.1 per 100 000 people over the period from 1993 to 2002. Most spinal fusions were performed in the 45- to 64-year age group. The number of patients with 2 or more comorbidities increased from 20% to 37%; however, the mortality and adverse outcome rates remained stable, and there was a slight decrease in LOS.

Conclusions

Cervical spondylotic myelopathy is one of the most common disorders treated by spine surgeons. There was a nearly 7-fold increase in the number of spinal fusions for CSM from 1993 to 2002. Despite continued increases in patient medical comorbidities, overall complication rates have remained stable at approximately 10.3% and mortality rates constant at 0.6%.

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.

Section snippets

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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