Kepler Christopher K, Vaccaro Alexander R, Hilibrand Alan S, Anderson D Greg, Rihn Jeffrey A, Albert Todd J, Radcliff Kristen E
From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
Spine (Phila Pa 1976). 2014 Sep 1;39(19):1584-9. doi: 10.1097/BRS.0000000000000486.
Retrospective review.
(1) To describe change in treatment patterns for degenerative spondylolisthesis (DS). (2) To report regional variation in treatment of DS. (3) To describe variation in surgeon-reported outcomes for DS based on treatment.
Spinal stenosis associated with DS is commonly treated with decompression and fusion but little is known about the optimal fusion technique. During a 6-month period, American Board of Orthopaedic Surgery step II candidates submit procedure lists; these lists have been stored in an electronic database since 1999.
The American Board of Orthopaedic Surgery database was retrospectively queried to identify patients who underwent surgery for DS from 1999 to 2011. Included patients underwent uninstrumented fusion, fusion with posterior instrumentation, fusion using interbody device, or decompression without fusion. Utilization of these procedures was analyzed by year and geographic region.
The study period included 5639 cases; the annual number of cases doubled during the study period. The percentage of cases treated with interbody fusion (IF) increased significantly throughout the study period, from 13.6% (1999-2001) to 32% (2009-2011) (P<0.001). The percentage of DS cases treated with posterolateral fusion peaked in 2003 then decreased as the rate of IF increased. In 2011, the rates of posterolateral fusion (40%) and posterolateral fusion with IF (37%) were nearly identical. The Northwest had the highest rate of IF (41%), >10% higher than any other region (P<0.001) and more than 23% higher than the Southeast (P<0.001).
Despite little evidence guiding treatment strategy for DS, national treatment patterns have changed dramatically during the past 13 years. The rapid adoption of IF and substantial regional variation in treatment utilization patterns raises questions about drivers of change including perceptions about associated fusion rates, the importance of sagittal balance and differential reimbursement.
回顾性研究。
（1）描述退行性腰椎滑脱（DS）治疗模式的变化。（2）报告DS治疗的地区差异。（3）描述基于治疗方式的外科医生报告的DS治疗效果差异。
与DS相关的椎管狭窄通常采用减压融合术治疗，但对于最佳融合技术知之甚少。在6个月的时间里，美国骨科医师协会第二步考试的考生提交手术清单；自1999年以来，这些清单一直存储在电子数据库中。
对美国骨科医师协会数据库进行回顾性查询，以确定1999年至2011年期间接受DS手术的患者。纳入的患者接受了非器械融合术、后路器械融合术、椎间融合器融合术或单纯减压术。按年份和地理区域分析这些手术的使用情况。
研究期间共纳入5639例病例；研究期间每年的病例数翻了一番。在整个研究期间，椎间融合术（IF）治疗的病例百分比显著增加，从1999 - 2001年的13.6%增至2009 - 2011年的32%（P<0.001）。经后外侧融合术治疗的DS病例百分比在2003年达到峰值，随后随着IF使用率的增加而下降。2011年，后外侧融合术（40%）和椎间融合器辅助后外侧融合术（37%）的使用率几乎相同。西北地区的IF使用率最高（41%），比其他任何地区高10%以上（P<0.001），比东南部地区高23%以上（P<0.001）。
尽管几乎没有证据指导DS的治疗策略，但在过去13年里，全国的治疗模式发生了巨大变化。IF的迅速采用以及治疗使用模式的显著地区差异引发了关于变化驱动因素的问题，包括对相关融合率的认知、矢状面平衡的重要性以及不同的报销政策。
4级。
