Abstract
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in the world. Surgical treatment is both medically and economically advantageous, and can be achieved through multiple approaches, with or without fusion. We used the Nationwide Inpatient Sample (NIS) database to better elucidate regional and socioeconomic variances in the treatment of CSM. Methods: The NIS database was queried for elective admissions with a primary diagnosis of CSM (ICD-9 721.1). This was evaluated for patients who also carried a diagnosis of anterior (ICD-9 81.02) or posterior cervical fusion (ICD-9 81.03), posterior cervical laminectomy (ICD 03.09), or a combination. We then investigated variances including regional trends and disparities according to hospital and insurance types. Results: During 2002-2012, 50605 patients were electively admitted with a diagnosis of CSM. Anterior fusions were more common in Midwestern states and in nonteaching hospitals. Fusion procedures were used more frequently than other treatments in private hospitals and with private insurance. Median hospital charges were also expectedly higher for fusion procedures and combined surgical approaches. Combined approaches were found to be significantly greater in patients with concurrent diagnoses of ossification of the posterior longitudinal ligament (OPLL) and CSM. Ultimately, there has been an increased utilization of fusion procedures versus nonfusion treatments, over the past decade, for patients with cervical myelopathy. Conclusions: Fusion surgery is being increasingly used for the treatment of CSM. Expensive procedures are being performed more frequently in both private hospitals and for those with private insurance, whereas the most economical procedure, posterior cervical laminectomy, was underutilized.
| Original language | English (US) |
|---|---|
| Journal | Surgical Neurology International |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2017 |
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Keywords
- Cervical spondylotic myelopathy
- Disparity
- Nationwide inpatient sample
- Regional
- Socioeconomic
- Spine fusion
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Socioeconomic and regional differences in the treatment of cervical spondylotic myelopathy. / Palejwala, Sheri; Rughani, Anand V.; Lemole, Gerald M; Dumont, Travis M.
In: Surgical Neurology International, Vol. 8, No. 1, 2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Socioeconomic and regional differences in the treatment of cervical spondylotic myelopathy
AU - Palejwala, Sheri
AU - Rughani, Anand V.
AU - Lemole, Gerald M
AU - Dumont, Travis M
PY - 2017
Y1 - 2017
N2 - Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in the world. Surgical treatment is both medically and economically advantageous, and can be achieved through multiple approaches, with or without fusion. We used the Nationwide Inpatient Sample (NIS) database to better elucidate regional and socioeconomic variances in the treatment of CSM. Methods: The NIS database was queried for elective admissions with a primary diagnosis of CSM (ICD-9 721.1). This was evaluated for patients who also carried a diagnosis of anterior (ICD-9 81.02) or posterior cervical fusion (ICD-9 81.03), posterior cervical laminectomy (ICD 03.09), or a combination. We then investigated variances including regional trends and disparities according to hospital and insurance types. Results: During 2002-2012, 50605 patients were electively admitted with a diagnosis of CSM. Anterior fusions were more common in Midwestern states and in nonteaching hospitals. Fusion procedures were used more frequently than other treatments in private hospitals and with private insurance. Median hospital charges were also expectedly higher for fusion procedures and combined surgical approaches. Combined approaches were found to be significantly greater in patients with concurrent diagnoses of ossification of the posterior longitudinal ligament (OPLL) and CSM. Ultimately, there has been an increased utilization of fusion procedures versus nonfusion treatments, over the past decade, for patients with cervical myelopathy. Conclusions: Fusion surgery is being increasingly used for the treatment of CSM. Expensive procedures are being performed more frequently in both private hospitals and for those with private insurance, whereas the most economical procedure, posterior cervical laminectomy, was underutilized.
AB - Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in the world. Surgical treatment is both medically and economically advantageous, and can be achieved through multiple approaches, with or without fusion. We used the Nationwide Inpatient Sample (NIS) database to better elucidate regional and socioeconomic variances in the treatment of CSM. Methods: The NIS database was queried for elective admissions with a primary diagnosis of CSM (ICD-9 721.1). This was evaluated for patients who also carried a diagnosis of anterior (ICD-9 81.02) or posterior cervical fusion (ICD-9 81.03), posterior cervical laminectomy (ICD 03.09), or a combination. We then investigated variances including regional trends and disparities according to hospital and insurance types. Results: During 2002-2012, 50605 patients were electively admitted with a diagnosis of CSM. Anterior fusions were more common in Midwestern states and in nonteaching hospitals. Fusion procedures were used more frequently than other treatments in private hospitals and with private insurance. Median hospital charges were also expectedly higher for fusion procedures and combined surgical approaches. Combined approaches were found to be significantly greater in patients with concurrent diagnoses of ossification of the posterior longitudinal ligament (OPLL) and CSM. Ultimately, there has been an increased utilization of fusion procedures versus nonfusion treatments, over the past decade, for patients with cervical myelopathy. Conclusions: Fusion surgery is being increasingly used for the treatment of CSM. Expensive procedures are being performed more frequently in both private hospitals and for those with private insurance, whereas the most economical procedure, posterior cervical laminectomy, was underutilized.
KW - Cervical spondylotic myelopathy
KW - Disparity
KW - Nationwide inpatient sample
KW - Regional
KW - Socioeconomic
KW - Spine fusion
UR - http://www.scopus.com/inward/record.url?scp=85020432547&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85020432547&partnerID=8YFLogxK
U2 - 10.4103/sni.sni_471_16
DO - 10.4103/sni.sni_471_16
M3 - Article
AN - SCOPUS:85020432547
VL - 8
JO - Surgical Neurology International
JF - Surgical Neurology International
SN - 2152-7806
IS - 1
ER -