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National and Regional Rates and Variation of Cervical Discectomy With and Without Anterior Fusion, 1990–1999

Angevine, Peter D., MD*; Arons, Ray R., DrPH; McCormick, Paul C., MD, MPH*

doi: 10.1097/01.BRS.0000058880.89444.A9
Health Services Research

Study Design. A national hospitalization database was used to determine rates and trends in the treatment of cervical disc disease.

Objective. To examine the temporal and geographic variations in hospitalizations and surgical procedures for cervical disc disease.

Summary of Background Data. Studies of spinal surgery during the 1980s showed significant increases in the rates for all procedures, particularly those involving fusion. The management of cervical disc disease continues to be controversial.

Methods. Data from the National Hospital Discharge Survey from 1990 through 1999 were analyzed. Records were selected and categorized according to an algorithm of International Classification of Diseases (ICD-9) procedure and diagnosis codes.

Results. During the study period, the rate of hospitalization for surgical and nonsurgical treatment of cervical disc disease did not increase significantly. There was, however, a statistically significant increase in the proportion of hospitalizations for the surgical treatment of cervical disc disease that included a fusion procedure. There also was significant geographic variation in the rate of fusion procedures, with the South having the highest rate.

Conclusions. Although the rate of surgery for cervical disc disease did not increase significantly during the 1990s, the rate of fusion procedures did rise significantly.

From the *Department of Neurological Surgery and the

†Mailman School of Public Health, Columbia University, New York, New York.

Peter D. Angevine was supported in part by the Wilder C. Penfield Clinical Investigation Fellowship of the Congress of Neurological Surgeons.

Acknowledgment date: July 15, 2002.

First revision date: September 20, 2002.

Acceptance date: September 24, 2002.

The submitted manuscript does not contain information about medical devices or drugs.

Professional organization funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

Address correspondence and reprint requests to Paul C. McCormick, MD, MPH, 710 West 168th Street, New York, NY 10032, USA; E-mail:

© 2003 Lippincott Williams & Wilkins, Inc.