Original ArticleVariability in Treatment for Patients with Cervical Spine Fracture and Dislocation: An Analysis of 107,152 Patients
Introduction
Cervical spine trauma is a major cause of mortality, morbidity, and healthcare expense in the United States. Approximately 55% of spinal cord injuries (SCIs) are due to cervical trauma,1 and 4.3% of all trauma AU: explain use of while versus and admissions are due to cervical spine injuries.2 Based on local resources, physician preference, the patient's medical condition, and the patient's injury, preferred treatment may include arthrodesis, halo placement, or cervical orthosis.3
Although overall cervical spine surgery rates have been shown to vary nearly 10-fold between geographic regions,4 those data largely reflect the treatment of cervical degenerative disease.5, 6 Using data from 1998 to 2002, Daniels et al.7 previously demonstrated a smaller 2.9-fold to 5.2-fold variability in rates of arthrodesis for cervical spine trauma patients depending on whether there was a cervical dislocation or associated SCI. Numerous studies have examined optimal treatment for cervical spine trauma8, 9, 10, 11, 12; however, data regarding the rate of spinal arthrodesis for cervical spine injuries since 2002 have not yet been reported.
In this study, we sought to examine trends in arthrodesis and halo/tong placement rates since 2000 and to study treatment variation based on hospital teaching status. We hypothesized that arthrodesis rates would vary between hospitals based on teaching status but that such variation would decrease over time.
Section snippets
Data Source
The Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) dataset was used.13 The dataset includes deidentifiable demographic information; International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedural codes; and hospital characteristics from approximately 1000 hospitals in 46 participating states of the United States. NIS data from 2000 to 2011 were evaluated. The annual NIS volume ranged from 7 million to 8 million
Patient Population
From 2000 to 2011, 120,613 patients were identified with a cervical spine injury. The 5197 patients who were transferred to another hospital and 7978 who died during hospitalization were excluded from analysis.
Of the remaining 107,152 patients, 87,785 (81.9%) had cervical fracture without SCI, 10,645 (9.9%) had cervical fracture with SCI, and 10,549 (9.8%) had cervical dislocation. The mean ages of patients with cervical fracture without SCI, cervical fracture with SCI, and cervical dislocation
Discussion
This study revealed significant variation in treatment for cervical trauma patients based on hospital teaching status, with significantly increasing rates of arthrodesis for cervical dislocation and SCI patients. Conversely, there was a decrease in arthrodesis rates for patients without SCI, and a precipitous drop in the use of halo/tong placement for all cervical injury patterns regardless of teaching status or diagnosis.
Daniels et al.7 previously investigated the treatment of 28,518 cervical
References (25)
- et al.
Controversies in the treatment of cervical spine dislocations
Spine J
(2009) - et al.
The Subaxial Cervical Spine Injury Classification System: an external agreement validation study
Spine J
(2013) - et al.
A review of uses of health care utilization databases for epidemiologic research on therapeutics
J Clin Epidemiol
(2005) - et al.
Epidemiology, demographics, and pathophysiology of acute spinal cord injury
Spine
(2001) - et al.
National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U.S. trauma centers
J Trauma
(1999) - et al.
Variation in surgical opinion regarding management of selected cervical spine injuries: a preliminary study
Spine
(1998) - et al.
The Dartmouth atlas of musculoskeletal health care
(2000) - et al.
Trends and geographic variations in major surgery for degenerative diseases of the hip, knee, and spine
Health Aff (Project Hope)
(2004) - et al.
Variation in surgical decision making for degenerative spinal disorders. Part II: cervical spine
Spine
(2005) - et al.
Variability in rates of arthrodesis procedures for patients with cervical spine injuries with and without associated spinal cord injury
J Bone Joint Surg Am Vol
(2007)
Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications
Eur Spine J
Variations in surgical treatment of cervical facet dislocations
Spine
Cited by (2)
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.