Passias Peter G, Marascalchi Bryan J, Boniello Anthony J, Yang Sun, Bianco Kristina, Jalai Cyrus M, Worley Nancy J, Horn Samantha R, Lafage Virginie, Bendo John A
Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States.
Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States.
J Clin Neurosci. 2017 Aug;42:75-80. doi: 10.1016/j.jocn.2017.04.017. Epub 2017 May 2.
Recent studies show increases in cervical spine surgery prevalence and cervical spondylotic myelopathy (CSM) diagnoses in the US. However, few studies have examined outcomes for CSM surgical management, particularly on a nationwide scale.
Evaluate national trends from 2001 to 2010 for CSM patient surgical approach, postoperative outcomes, and hospital characteristics.
A retrospective nationwide database analysis provided by the Nationwide Inpatient Sample (NIS) including CSM patients aged 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty from 2001 to 2010. Patients with fractures, 9+ levels fused, or any cancer were excluded. Measures included demographics, hospital data, and procedure-related complications. Yearly trends were analyzed using linear regression modeling.
54,348 discharge cases were identified. ACDF, posterior only, and combined anterior/posterior approach volumes significantly increased from 2001 to 2010 (98.62%, 303.07%, and 576.19%; respectively, p<0.05). However, laminoplasty volume remained unchanged (p>0.05). Total charges for ACDF, posterior only, combined anterior/posterior, and laminoplasty approaches all significantly increased (138.72%, 176.74%, 182.48%, and 144.85%, respectively; p<0.05). For all procedures, overall mortality significantly decreased by 45.34% (p=0.001) and overall morbidity increased by 33.82% (p=0.0002). For all procedures except ACDF, which saw a significantly decrease by 8.75% (p<0.0001), length of hospital stay was unchanged.
For CSM patients between 2001 and 2010, combined surgical approach increased sixfold, posterior only approach increased threefold, and ACDF doubled; laminoplasties without fusion volume remained the same. Mortality decreased whereas morbidity and total charges increased. Length of stay decreased only for ACDF approach. This study provides clinically useful data to direct future research, improving patient outcomes.
近期研究表明，美国颈椎手术的患病率及脊髓型颈椎病（CSM）的诊断率有所上升。然而，很少有研究探讨CSM手术治疗的结果，尤其是在全国范围内。
评估2001年至2010年CSM患者手术方式、术后结果及医院特征的全国趋势。
对全国住院患者样本（NIS）提供的数据库进行回顾性分析，纳入2001年至2010年年龄在25岁及以上、接受过前路和/或后路颈椎融合术或椎板成形术的CSM患者。排除有骨折、融合节段达9个以上或患有任何癌症的患者。测量指标包括人口统计学数据、医院数据及与手术相关的并发症。使用线性回归模型分析年度趋势。
共识别出54348例出院病例。从2001年到2010年，前路颈椎间盘切除融合术（ACDF）、单纯后路手术及前后联合手术的例数显著增加（分别为98.62%、303.07%和576.19%；p<0.05）。然而，椎板成形术的例数保持不变（p>0.05）。ACDF、单纯后路手术、前后联合手术及椎板成形术的总费用均显著增加（分别为138.72%、176.74%、182.48%和144.85%；p<0.05）。对于所有手术，总体死亡率显著下降45.34%（p=0.001），总体发病率增加33.82%（p=0.0002）。除ACDF的住院时间显著缩短8.75%（p<0.0001）外，所有手术的住院时间均无变化。
2001年至2010年期间，CSM患者的联合手术方式增加了6倍，单纯后路手术方式增加了3倍，ACDF增加了1倍；未融合的椎板成形术例数保持不变。死亡率下降，而发病率和总费用增加。仅ACDF手术的住院时间缩短。本研究提供了具有临床实用价值的数据，可指导未来研究，改善患者预后。
