Upfill-Brown Alexander, Policht Jeremy, Sperry Beau P, Ghosh Durga, Shah Akash A, Sheppard William L, Lord Elizabeth, Shamie Arya Nick, Park Don Y
Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
J Spine Surg. 2022 Sep;8(3):343-352. doi: 10.21037/jss-22-4.
Lumbar fusion (LF) is commonly performed to manage lumbar degenerative disc disease (LDDD) that has failed conservative measures. However, lumbar disc replacement (LDR) procedures are increasingly prevalent and designed to preserve motion in carefully selected patients.
A retrospective cohort study was performed using the National Inpatient Sample (NIS), queried from 2010 to 2019 to identify patients undergoing single and double-level LF or LDR with a diagnosis of LDDD using International Classification of Diseases (ICD) 9th (ICD-9) and 10th (ICD-10) revision diagnostic and procedure codes. Propensity score matching (PSM) with a ratio of 2:1 was performed. All cost estimates reflect reported hospital costs adjusted to December 2019 United States Dollars.
A total of 1,129,121 LF cases (99.3%) and 8,049 LDR cases (0.7%) were identified, with 364,637 (32.3%) and 712 (8.8%) comprising two-level surgeries, respectively. 1,712 LDRs were performed in 2010 (1.27% of all), decreasing to 565 in 2013 (0.52%), and increased slightly to 870 in 2019 (0.74%). LDR patients were significantly more likely to be younger (mean age 41.2 57.1, P<0.001) and healthier (mean ECI 0.88 1.80, P<0.001). On matched analysis, LDR hospital costs were $4,529 less (P<0.001) and length of stay was 0.65 days shorter (P<0.001) than LF patients. LDR patients had lower rates of any complication (7.0% 13.2%, P<0.001), neurologic complication (3.0% 4.2%, P=0.006), and blood transfusion (3.1% 8.1%, P<0.001) compared to LF patients.
The prevalence of LDR procedures decreased from 2010-2017 but began to increase again in 2018 and 2019. Single-level LDR was associated with reduced costs and length of stay (LOS), and lower rates of blood transfusion compared to LF in patients with LDDD.
腰椎融合术（LF）常用于治疗经保守治疗无效的腰椎退行性椎间盘疾病（LDDD）。然而，腰椎间盘置换术（LDR）越来越普遍，其设计目的是在精心挑选的患者中保留活动度。
使用国家住院样本（NIS）进行了一项回顾性队列研究，查询了2010年至2019年期间使用国际疾病分类（ICD）第9版（ICD - 9）和第10版（ICD - 10）修订版诊断和手术编码诊断为LDDD并接受单节段和双节段LF或LDR的患者。进行了比例为2:1的倾向得分匹配（PSM）。所有成本估计反映了根据2019年12月美元调整后的报告医院成本。
共识别出1,129,121例LF病例（99.3%）和8,049例LDR病例（0.7%），其中分别有364,637例（32.3%）和712例（8.8%）为双节段手术。2010年进行了1,712例LDR手术（占所有手术的1.27%），2013年降至565例（0.52%），2019年略有增加至870例（0.74%）。LDR患者明显更年轻（平均年龄41.2对57.1，P<0.001）且更健康（平均ECI 0.88对1.80，P<0.001）。在匹配分析中，LDR患者的住院成本比LF患者少4,529美元（P<0.001），住院时间短0.65天（P<0.001）。与LF患者相比，LDR患者发生任何并发症（7.0%对13.2%，P<0.001）、神经并发症（3.0%对4.2%，P = 0.006）和输血（3.1%对8.1%，P<0.001）的发生率更低。
LDR手术的患病率在2010 - 2017年下降，但在2018年和2019年又开始上升。在患有LDDD的患者中，单节段LDR与成本降低、住院时间缩短以及输血率降低相关。
