Geographical and Specialty-specific Variation in the Utilization of Laminoplasty for Cervical Myelopathy.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2024-10-01 Epub Date: 2024-04-08 DOI:10.1097/BSD.0000000000001617

Aymen Alqazzaz, Thompson Zhuang, Bijan Dehghani, Stephen R Barchick, Ali K Ozturk, Amrit S Khalsa, David S Casper

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引用次数: 0

Abstract

Study design: Level IV retrospective cohort study.

Objectives: Despite the positive outcomes associated with laminoplasty, there is significant surgeon variability in the use of laminoplasty for cervical myelopathy in the United States. In this study, we explored how geographic and specialty-specific differences may influence the utilization of laminoplasty to treat cervical myelopathy.

Background: We queried the Mariner 157 database (PearlDiver, Inc.), a national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients from 2010 to 2021.

Patients and methods: Using the International Classification of Diseases 10th Revision/International Classification of Diseases Ninth Revision and Current Procedural Terminology codes, we identified all patients with a diagnosis of cervical myelopathy who had undergone multilevel posterior cervical decompression and fusion (PCDF) or laminoplasty. We further analyzed patients' demographics, comorbidities, geographical location, and specialty of the surgeon (neurosurgery or orthopedic spine surgery).

Results: There were 34,432 patients with a diagnosis of cervical myelopathy, of which 4,033 (11.7%) underwent laminoplasty and 30,399 (88.3%) underwent multilevel PCDF. Northeast, South, and West regions had lower percentages of laminoplasty utilization compared with the Midwest in terms of total case mix between laminoplasty and PCDF. In addition, 2,300 (57.0%) of the laminoplasty cases were performed by orthopedic spine surgeons compared with 1,733 (43.0%) by neurosurgeons. Temporal trends in laminoplasty utilization were stable for orthopedic surgeons, whereas laminoplasty utilization decreased over time between 2010 and 2021 for neurosurgeons (P < 0.001).

Conclusions: Utilization of laminoplasty in the United States is not well defined. Our results suggest a geographical and training-specific variation in the utilization of laminoplasty. Surgeons with orthopedic training were more likely to perform laminoplasty compared with surgeons with a neurosurgery training background. In addition, we found greater utilization of laminoplasty in the Midwest compared with other regions.

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使用板层成形术治疗颈椎病的地域和专科差异。

研究设计研究目的：IV级回顾性队列研究：尽管板层成形术具有积极的疗效，但在美国，外科医生在使用板层成形术治疗颈椎病方面存在很大的差异。在本研究中，我们探讨了地域和专科差异如何影响使用板层成形术治疗颈椎病：我们查询了 Mariner 157 数据库（PearlDiver, Inc：我们使用《国际疾病分类》第十次修订版/《国际疾病分类》第九次修订版和《现行手术术语》代码，确定了所有诊断为颈椎脊髓病并接受过多层次颈椎后路减压融合术（PCDF）或椎板成形术的患者。我们进一步分析了患者的人口统计学特征、合并症、地理位置和外科医生的专业（神经外科或脊柱矫形外科）：共有 34,432 名患者被诊断为颈椎脊髓病，其中 4,033 人（11.7%）接受了椎板成形术，30,399 人（88.3%）接受了多层次 PCDF。与中西部地区相比，东北部、南部和西部地区在椎板成形术和PCDF之间的总病例组合中使用椎板成形术的比例较低。此外，2300 例（57.0%）脊柱板层成形术由脊柱矫形外科医生实施，而 1733 例（43.0%）由神经外科医生实施。骨科医生的板层成形术使用率呈稳定趋势，而神经外科医生的板层成形术使用率在2010年至2021年期间有所下降（P < 0.001）：结论：美国的板层成形术使用情况尚不明确。我们的研究结果表明，板层成形术的使用存在地域和培训方面的差异。与接受过神经外科培训的外科医生相比，接受过骨科培训的外科医生更有可能实施板层成形术。此外，我们还发现与其他地区相比，中西部地区更多使用板层成形术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.