Abstract
PurposeThe purpose of this study is to assess the trends and regional variations in the operative techniques used for degenerative or rheumatoid cervical spine disease in Finland between 1999 and 2015.MethodsThe Finnish Hospital Discharge Register (FHDR) was searched for the data on all the primary operations for degenerative cervical spine disease (DCSD) or rheumatoid atlanto-axial subluxation (rAAS). Operative codes were used to identify the patients from the FHDR and combined with diagnosis codes to verify patient inclusion. The patients were classified into three groups: anterior cervical decompression and fusion (ACDF), posterior decompression and fusion (PDF) and decompression.ResultsA total of 19,701 primary operations were included. The adjusted incidence of ACDF rose from 6.5 to 27.3 operations/100,000 adults. ACDF became the favoured technique in all the diagnostic groups except AAS, and by 2015, ACDF comprised 84.5% of the operations. The incidence of PDF for DCSD increased from 0.2 to 0.7/100,000 people. Solely decompressive operations declined from 13.7 to 4.0 operations/100,000 people. The regional differences in the incidence of operations were most marked in the incidence of ACDF, with overall incidences ranging from 11.2 to 37.0 operations/100,000. The distribution of the operative techniques used varied as well.ConclusionsBetween 1999 and 2015, the operative techniques used for DCSD changed from prevalently decompressive to utilising ACDF in 68.8 to 91.0% of the operations, depending on the treating hospital. ACDF became the most commonly applied technique for all degenerative diagnoses except AAS.
Highlights
The rate of surgery for degenerative cervical spine disease (DCSD) increased by 74% in Norway between 2008 and2014 [15] and in the United States (US) by almost 150% between 1990 and 2013 [17, 24]
There were 19,701 patients identified from the Finnish Hospital Discharge Register (FHDR) after the data purification who had undergone a primary cervical spine operation for degenerative or rheumatoid cervical spine disease
48.4% were performed for rheumatoid atlanto-axial subluxation
Summary
The rate of surgery for degenerative cervical spine disease (DCSD) increased by 74% in Norway between 2008 and2014 [15] and in the United States (US) by almost 150% between 1990 and 2013 [17, 24]. The rate of surgery for degenerative cervical spine disease (DCSD) increased by 74% in Norway between 2008 and. In the US, anterior cervical discectomy and fusion (ACDF) became the mainstay of treatment already in the late 1990s [24]. This article is part of the Topical Collection on Spine degenerative. Acta Neurochir (2019) 161:2161–2173 of surgery for DCSD as well as the use of ACDF has declined slightly [17]. The incidence of posterior decompression and fusion (PDF) has increased steeply [17, 19, 23, 24]. The techniques applied vary between the regions in the US [3, 33] as well as internationally [8]
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