Clinical Research Fellow Ohio State University Wexner Medical Center
Disclosure(s):
Muhammad Talal Ibrahim, MD: No financial relationships to disclose
Introduction: The volume of cervical spine surgeries is reported to have been increasing with the rise of aging population. Various procedures are offered, often with overlapping indications. These include anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), cervical disc arthroplasty (CDA), and Laminectomy / Foraminotomy / Facetectomy (LFF). The aim of this study is to evaluate the trends of these cervical spine procedures in the US.
Methods: This descriptive study was conducted using the PearlDiver Mariner Database, that covers 170 million patients in the US from 2010 till first quarter of 2023. Patients undergoing ACDF, PCF, CDA, and LFF were identified. These groups were then analyzed for age, gender, number of procedures per year, average reimbursement per patient per year (reimbursement/patient), region, and insurance plan.
Results: This study included 886,672 patients who underwent cervical spine surgery, with 71.6% undergoing ACDF, 15.5% undergoing LFF, 11.7% undergoing PCF, and only 1.2% undergoing CDA. ACDF was most commonly performed in patients aged 55 – 74 years (50.6% of ACDF cases) followed by patients aged ≤ 54 years (43.8%). PCF and LFF had slightly higher proportion of patients aged ≥ 75 years as compared to ACDF, while CDA was most popular among patients aged ≤ 54 years (representing 67.8% of CDA patients). The numbers of ACDF remained stable over the years, while the remaining three increased in numbers, with the sharpest rise seen in CDA (31 in 2010 to 1,632 in 2022). Reimbursement/patient rose for all four procedures from 2010 till 2021, with a decline in 2022 for all four procedures. Most patients were from the southern US, with a similar proportion of the procedures in all four regions of the US, except for CDA which was more common in the West. Commercial insurance was most common for all procedures followed by Medicare.
Conclusion : This study identifies trends in the cervical spine surgery in US over the past decade (2010 – 2022). ACDF was most common procedure, with LFF and PCF seeing increased proportion in patients aged ≥ 75 years. The incidence of LFF, PCF, and CDA rose over the study period while ACDF remained stable.