Citation

Wang J, Eltorai AEM, DePasse JM, Durand W, Reid D, Daniels AH. World Neurosurg. 2018; 114: e151-e157.

Affiliation

Division of Spine Surgery, Rhode Island Hospital, 593 Eddy St, Providence, RI; Department of Orthopaedic Surgery, Rhode Island Hospital, 593 Eddy St, Providence, RI; Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.wneu.2018.02.119

PMID

29501518

Abstract

BACKGROUND: Cervical spine injuries are a common cause of morbidity and mortality, but optimal treatment is debated. Prior studies showed substantial variation in treatment. We examined treatment variation in arthrodesis and halo/tong placement in cervical spine injury patients.

METHODS: We used the Healthcare Cost and Utilization Project National Inpatient Sample, 2000-2011. Patients were identified based on International Classification of Diseases, 9^thRevision diagnosis codes. Using chi-square analysis, spinal arthrodesis and halo/tong placement rates were compared between hospitals based on teaching status.

RESULTS: We examined 107,152 patients. Arthrodesis rates fell from 25.2% to 20.6% (p<0.001); halo/tong placement rates fell from 13.2% to 3.6% (p<.001). For patients with cervical fracture without spinal cord injury (SCI), arthrodesis rates fell from 17.6% to 13.9% (p<0.001), for cervical fracture patients with SCI, arthrodesis rates rose from 50.0% to 58.9% (p<0.001), and for cervical dislocation patients, arthrodesis rates rose from 47.6% to 57.5% (p<0.001). Teaching hospitals had higher arthrodesis rates than non-teaching hospitals for patients with cervical fractures with SCI (57.3% vs 53.4%, p=.001) and higher halo/tong placement rates for patients with cervical dislocations (2.7% vs 1.7%, p=.004). Individual hospital comparison showed 3.5-fold variation in arthrodesis rates in 2000-2002, which fell to 3.0-fold by 2009-2011.

CONCLUSIONS: Arthrodesis rates for non-SCI patients decreased, while arthrodesis rates for cervical dislocation and SCI patients increased from 2000 to 2011. Rates of halo/tong placement rapidly decreased for cervical spine trauma at all hospitals. Further studies for optimal treatment of spine trauma may lead to continued decreases in treatment variability.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Cervical spine trauma; arthrodesis; cervical fractures; halo/tong placement; treatment variation