Grisdela Phillip, Buser Zorica, D'Oro Anthony, Paholpak Permsak, Liu John C, Wang Jeffrey C
Department of Orthopaedic Surgery, Keck School of Medicine, Elaine Stevely Hoffman Medical Research Center, University of Southern California, 2011 Zonal Ave., HMR 710, Los Angeles, CA, 90033, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Eur Spine J. 2017 Sep;26(9):2386-2392. doi: 10.1007/s00586-017-5120-9. Epub 2017 May 9.
This study defined the incidence and trends of surgeries performed for patients with cervical disc degeneration with and without tobacco use disorder (TUD).
This study utilized the Humana Inc. database between 2007 and 2013 to identify patients with cervical disc degeneration with or without myelopathy. International Classification of Diseases, ninth revision (ICD-9) and Current Procedural Terminology (CPT) codes determined the initial diagnosis of disc degeneration, myelopathy status and TUD, whether patients received surgery, and TUD status at surgery.
The prevalence of disc degeneration with myelopathy increased by 32.8% between 2007 and 2013, while disc disease with myelopathy and TUD increased by 91.6%. For patients without myelopathy, the prevalence of disc degeneration alone increased by 65.4%, and disc degeneration with myelopathy increased by 148.7%. Of myelopathy patients, 1717 (6.4%) had TUD and 1024 (59.6%) received surgery, compared to 6508 patients without TUD (26.1%). For patients without myelopathy, 11,337 (3.5%) had TUD and 787 (6.9%) underwent surgery, compared to 9716 patients (3%) without TUD. Of surgical patients, 781 (76.3%) with myelopathy and TUD still had a TUD diagnosis at surgery, and 542 (68.9%) of patients without myelopathy still had a TUD diagnosis at surgery.
The prevalence of degenerative disc disease and TUD has increased more than disc disease alone. Patients with TUD were more likely to get surgery, and to have surgeries earlier than patients without TUD. Patients with TUD at the time of the diagnosis of their disc degeneration likely still had a TUD diagnosis at the time of surgery.
本研究确定了患有和未患有烟草使用障碍（TUD）的颈椎间盘退变患者进行手术的发生率及趋势。
本研究利用2007年至2013年期间的Humana公司数据库，识别患有或未患有脊髓病的颈椎间盘退变患者。国际疾病分类第九版（ICD - 9）和当前手术操作术语（CPT）编码确定了椎间盘退变的初始诊断、脊髓病状态和TUD，患者是否接受手术，以及手术时的TUD状态。
2007年至2013年期间，伴有脊髓病的椎间盘退变患病率增加了32.8%，而伴有脊髓病和TUD的椎间盘疾病患病率增加了91.6%。对于无脊髓病的患者，单纯椎间盘退变患病率增加了65.4%，伴有脊髓病的椎间盘退变患病率增加了148.7%。在脊髓病患者中，1717例（6.4%）患有TUD，1024例（59.6%）接受了手术，相比之下，6508例无TUD的患者（26.1%）接受了手术。对于无脊髓病的患者，11337例（3.5%）患有TUD，787例（6.9%）接受了手术，相比之下，9716例无TUD的患者（3%）接受了手术。在手术患者中，781例（76.3%）伴有脊髓病和TUD的患者在手术时仍被诊断为患有TUD，542例（68.9%）无脊髓病的患者在手术时仍被诊断为患有TUD。
退行性椎间盘疾病和TUD的患病率增长幅度超过了单纯的椎间盘疾病。患有TUD的患者比无TUD的患者更有可能接受手术，且手术时间更早。在诊断为椎间盘退变时患有TUD 的患者在手术时可能仍被诊断为患有TUD。
