Researchers report increase in spine fusions, structural allografts (OrthoSuperSite)
Between 1999 and 2008, orthopedic spine surgery rates increased, with more surgeons performing fusions and using structural allografts, interbody devices or anterior cervical plates, according to Boston researchers.
The researchers aimed to determine the change in rates and types of procedures performed for cervical spine surgery by geographic region. The study highlights the need for better scientific research into the best techniques for and the outcomes of cervical spine surgery, Kevin J. McGuire, MD, MS and his coauthors wrote in their report.
“[O]ne must question the increase in surgical rates among orthopedic candidates, and continued regional variations in the types of procedures,” the authors wrote
The researchers pulled records from the American Board of Orthopedic Surgeons part II examination from 1999 to 2008. They used Current Procedural Terminology and ICD-9 codes to pinpoint what procedures and types of plating orthopedists were using. They measured outcomes using physician workforce and rates and variations in the different procedure types, according to the study abstract.
Orthopedic spine surgeon candidates increased 24% between 1999 and 2008, with discectomies with fusions for degenerative cervical disc disease increasing 67%, the authors wrote in their abstract. More surgeons used interbody devices, anterior cervical plating and allografts during this period, while autograft use decreased. In the Southwest and Southeast, more orthopedists used interbody devices than in the Midwest. Southwestern and Northeastern orthopedists used allograft more often than the Midwest. The Midwest performed used allografts more than the Southwest, Northeast and Southeast. Northeastern orthopedists were less likely to use anterior cervical plating than the Midwest, whereas the Southeast was more likely to use anterior cervical plating than the Midwest.
“The challenge of new technologies and the lack of evidence about comparative effectiveness…limit our ability to provide an informed choice to patients facing preference-based decisions,” the authors wrote.
Reference:
- McGuire KJ, Harrast J, Herkowitz H, Weinstein JN. Geographic variation in the surgical treatment of degenerative cervical disc disease: American Board of Orthopedic Surgery Quality Improvement Initiative; Part II candidates. Spine. 2011. doi: 10.1097/BRS.0b013e318212bb61