Surgical techniques for degenerative cervical spine in Finland from 1999 to 2015

Abstract

PurposeThe purpose of this study is to assess the trends and regional variations in the operative techniques used for degenerative or rheumatoid cervical spine disease in Finland between 1999 and 2015.MethodsThe Finnish Hospital Discharge Register (FHDR) was searched for the data on all the primary operations for degenerative cervical spine disease (DCSD) or rheumatoid atlanto-axial subluxation (rAAS). Operative codes were used to identify the patients from the FHDR and combined with diagnosis codes to verify patient inclusion. The patients were classified into three groups: anterior cervical decompression and fusion (ACDF), posterior decompression and fusion (PDF) and decompression.ResultsA total of 19,701 primary operations were included. The adjusted incidence of ACDF rose from 6.5 to 27.3 operations/100,000 adults. ACDF became the favoured technique in all the diagnostic groups except AAS, and by 2015, ACDF comprised 84.5% of the operations. The incidence of PDF for DCSD increased from 0.2 to 0.7/100,000 people. Solely decompressive operations declined from 13.7 to 4.0 operations/100,000 people. The regional differences in the incidence of operations were most marked in the incidence of ACDF, with overall incidences ranging from 11.2 to 37.0 operations/100,000. The distribution of the operative techniques used varied as well.ConclusionsBetween 1999 and 2015, the operative techniques used for DCSD changed from prevalently decompressive to utilising ACDF in 68.8 to 91.0% of the operations, depending on the treating hospital. ACDF became the most commonly applied technique for all degenerative diagnoses except AAS.Electronic supplementary materialThe online version of this article (10.1007/s00701-019-04026-9) contains supplementary material, which is available to authorized users.

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

“…The number of vertebral levels operated may explain at least partially the differences in the reoperation rates between the ACDF and decompression groups, especially since the risk of reoperation did not increase between 1999 and 2015 despite the change in the operative techniques from predominantly decompressive to ACDF. 19 Further limitations of the operative coding system have been discussed previously. 7 , 19 Data on some potential confounding factors, especially smoking, are missing.…”

“… 19 Further limitations of the operative coding system have been discussed previously. 7 , 19 Data on some potential confounding factors, especially smoking, are missing. 13 , 17 …”

“…The risk of reoperation did not increase between 1999 and 2015, even though the age- and sex-adjusted rate of primary operations for DCSD increased by 36% and the use of ACDF increased to over 80% of the primary operations during the same period. 7 , 19 As most of the reoperations occurred within the first 6 postoperative years, we presume that the follow-up was sufficiently long to analyze the trends in the reoperations. Such patient-level time trends in reoperations have not been assessed previously.…”

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

“…19 Further limitations of the operative coding system have been discussed previously. 7,19 Data on some potential confounding factors, especially smoking, are missing. 13,17 Interpretation The reported reoperation rates have varied considerably (Table 9).…”

Zukunft der operativen Therapie degenerativer Wirbelsäulenerkrankungen: Kontra – Wandel hin zu weniger Operationen aufgrund fehlender Evidenz

“…So konnte bspw. für Finnland die Versorgung der zervikalen Bandscheibendegeneration mit ihren regionalen Unterschieden eindrucksvoll dargestellt werden [24]. Ergebnisse aus den USA bestätigen diese Entwicklung und konnten zeigen, dass zwar die technisch komplexen Eingriffe mit zirkumferenziellen HWS-Instrumentationen um den Faktor 4 angestiegen sind, diese jedoch nur einen Bruchteil der gesamten Steigerungsraten ausmachen [3].…”