National trends in spinal fusion for cervical spondylotic myelopathy

Lad, Shivanand P.; Patil, Chirag G.; Berta, Scott C.; Santarelli, Justin; Ho, Christopher; Boakye, Maxwell

doi:10.1016/j.surneu.2008.02.045

Cited by 121 publications

(87 citation statements)

References 5 publications

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“…In recent years, surgical treatment options have been increasingly used. 12 Multiple studies have sought to assess trends related to these procedures. opting to undergo surgical treatment has steadily increased, the overall complication and mortality rates have remained relatively stable at 10.3%.…”

Section: Discussionmentioning

confidence: 99%

“…opting to undergo surgical treatment has steadily increased, the overall complication and mortality rates have remained relatively stable at 10.3%. 12 However, use of the NIS database may not adequately capture complications occurring after patient discharge, thereby underestimating complication occurrence. We therefore conducted a retrospective analysis of CSM patients undergoing surgical treatment using MarketScan, a longitudinal national database.…”

Section: Discussionmentioning

confidence: 99%

“…12 Thus, a thorough analysis of trends related to these conditions was warranted. We performed a retrospective analysis of the complications and costs of surgical treatments for CSM on a national level.…”

Section: Methods Data Sourcementioning

confidence: 99%

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Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database

Veeravagu¹,

Connolly²,

Lamsam³

et al. 2016

FOC

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OBJECTIVE The authors performed a population-based analysis of national trends, costs, and outcomes associated with cervical spondylotic myelopathy (CSM) in the United States. They assessed postoperative complications, resource utilization, and predictors of costs, in this surgically treated CSM population. METHODS MarketScan data (2006–2010) were used to retrospectively analyze the complications and costs of different spine surgeries for CSM. The authors determined outcomes following anterior cervical discectomy and fusion (ACDF), posterior fusion, combined anterior/posterior fusion, and laminoplasty procedures. RESULTS The authors identified 35,962 CSM patients, comprising 5154 elderly (age ≥ 65 years) patients (mean 72.2 years, 54.9% male) and 30,808 nonelderly patients (mean 51.1 years, 49.3% male). They found an overall complication rate of 15.6% after ACDF, 29.2% after posterior fusion, 41.1% after combined anterior and posterior fusion, and 22.4% after laminoplasty. Following ACDF and posterior fusion, a significantly higher risk of complication was seen in the elderly compared with the nonelderly (reference group). The fusion level and comorbidity-adjusted ORs with 95% CIs for these groups were 1.54 (1.40–1.68) and 1.25 (1.06–1.46), respectively. In contrast, the elderly population had lower 30-day readmission rates in all 4 surgical cohorts (ACDF, 2.6%; posterior fusion, 5.3%; anterior/posterior fusion, 3.4%; and laminoplasty, 3.6%). The fusion level and comorbidity-adjusted odds ratios for 30-day readmissions for ACDF, posterior fusion, combined anterior and posterior fusion, and laminoplasty were 0.54 (0.44–0.68), 0.32 (0.24–0.44), 0.17 (0.08–0.38), and 0.39 (0.18–0.85), respectively. CONCLUSIONS The authors' analysis of the MarketScan database suggests a higher complication rate in the surgical treatment of CSM than previous national estimates. They found that elderly age (≥ 65 years) significantly increased complication risk following ACDF and posterior fusion. Elderly patients were less likely to experience a readmission within 30 days of surgery. Postoperative complication occurrence, and 30-day readmission were significant drivers of total cost within 90 days of the index surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database

Veeravagu¹,

Connolly²,

Lamsam³

et al. 2016

FOC

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“…In a study conducted in US, Lad SP, Patil CG et al also showed similar incidence of co morbidities like hypertension (30%), diabetes mellitus (28%) and other (37%). 15 But the frequency of co morbidities varies in different populations.…”

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confidence: 99%

Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala

Joseph

2016

Int J Basic Clin Pharmacol

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Background: This study was undertaken to study the determinants, clinical characteristics and treatment pattern of neck pain in patients attending outpatient department of Physical medicine and Rehabilitation in a tertiary care hospital.Methods: Study comprehended single patient visit. Data regarding patient demographics, characteristics of neck pain and clinical diagnosis, drugs prescribed to each patient were recorded in a pre prepared proforma. Clinician’s opinion about patient’s X-ray of cervical spine and the data regarding alternative treatment modalities were also noted. Data analysis was done with the help of excel 2007 and SPSS 16 statistical software.Results: Among 170 patients included in the study 38.8% of patients were in the age group of 40-49 years with M:F ratio-1:2.9. 98.8% of patients experienced radiation of neck pain to one or both arms. Neck pain also was associated with numbness in arm (82.4%), forearm (61.8%) or hand (59.4%) and neck stiffness (99.4%). Half of the study population were found to have neurological deficit. 98.2% of patients had positive radiological evidence for neck pain. Cervical spondylosis (85.9%) was the most commonly observed cause for neck pain. All patients received pharmacotherapy with NSAIDS and muscle relaxants. Diclofenac was the most commonly prescribed NSAID. 45% of the patients received alternative and complementary treatments for neck pain.Conclusions: NSAIDs and central skeletal muscle relaxants are the commonly prescribed medications and alternative treatments like spinal manipulation and physiotherapy appears to be beneficial in patients with neck pain.

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“…A ventral approach allows for direct decompression of ventral pathological entities in kyphotic, neutral, or lordotic spines, and avoids the pain associated with a posterior paraspinal musculature stripping approach, but is associated with its own compli cations including dysphagia, hoarseness, and cardiopul monary events. 1,4,5,10,21 Traditional postoperative outcome measures such as complications, readmission rates, revision surgery rates, and return to work measures do not fully encompass the patient experience following surgery and the relative ad vantages and disadvantages of each of the approaches. Recent studies have increasingly investigated financial cost and QOL outcomes for these 2 surgeries.…”

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confidence: 99%

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

Alvin

Lubelski

Benzel

et al. 2013

FOC

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Cervical spondylotic myelopathy (CSM) often can be surgically treated by either ventral or dorsal decompression and fusion. However, there is a lack of high-level evidence on the relative advantages and disadvantages for these treatments of CSM. The authors' goal was to provide a comprehensive review of the relative benefits of ventral versus dorsal fusion in terms of quality of life (QOL) outcomes, complications, and costs. They reviewed 7 studies on CSM published between 2003 and 2013 and summarized the findings for each category. Both procedures have been shown to lead to statistically significant improvement in clinical outcomes for patients. Ventral fusion surgery has been shown to yield better QOL outcomes than dorsal fusion surgery. Complication rates for ventral fusion surgery range from 11% to 13.6%, whereas those for dorsal fusion surgery range from 16.4% to 19%. Larger randomized controlled trials are needed, with particular emphasis on QOL and minimum clinically important differences.

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National trends in spinal fusion for cervical spondylotic myelopathy

Cited by 121 publications

References 5 publications

Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database

Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database

Determinants, characteristics and treatment of neck pain in a tertiary care hospital in Kerala

Ventral fusion versus dorsal fusion: determining the optimal treatment for cervical spondylotic myelopathy

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