Abstract
Background context
Surgical treatment for lumbar degenerative disc disease (DDD) remains controversial.
Options include anterior lumbar interbody fusion, posterior approach fusion procedures
such as posterior lumbar interbody fusion (PLIF) and posterolateral lumbar fusion
(PLF), anterior and posterior lumbar fusion (APLF), and total disc replacement (TDR).
However, the trends during the last decade are uncertain.
Purpose
To examine the trends in the surgical treatment for lumbar DDD on a national level.
Study design
A retrospective analysis of population-based national hospital discharge data collected
for the Nationwide Inpatient Sample (NIS).
Patient sample
In the NIS from 2000 to 2009, patients aged 18 years or older with primary diagnosis
of lumbar/lumbosacral DDD who underwent surgical treatment were included.
Outcome measures
Trends in the surgical treatment for lumbar DDD.
Methods
Clinical data were derived from the NIS between 2000 and 2009. Patients aged 18 years
or older with a primary diagnosis of lumbar/lumbosacral DDD who underwent spinal fusion
or TDR were identified. Data regarding patient- and health care system-related characteristics
were retrieved and analyzed.
Results
A total of 380,305 patients underwent surgical treatment for lumbar DDD between 2000
and 2009. Population adjusted incidence increased 2.4-fold from 2000 to 2009. Among
the procedures, APLF increased 3.0-fold and PLIF/PLF increased 2.8-fold. Total disc
replacement did not increase significantly. Anterior lumbar interbody fusion was performed
in 16.8% of patients, PLIF/PLF in 67.9%, APLF in 13.6%, and TDR in 1.8%. Surgical
treatment for lumbar DDD was 1.8 times more common in the Midwest region and 1.7 times
more common in the South region than in the Northeast region. Total disc replacement
was more common in younger patients and in the Northeast region. Poterior lumbar interbody
fusion/PLF was more common in older patients and in the South region.
Conclusions
During the last decade, surgical treatment for lumbar DDD has increased 2.4-fold in
the United States. Although all fusion procedures significantly increased, TDR did
not increase. Surgical treatment for lumbar DDD was more common in the Midwest and
South regions. Trends in the procedures were different depending on the age group
and hospital region.
Keywords
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Article info
Publication history
Published online: October 01, 2014
Accepted:
September 15,
2014
Received in revised form:
August 6,
2014
Received:
February 24,
2014
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: HY: Nothing to disclose. DY: Nothing to disclose.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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