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  • Trends in Spinal Fusion Surgery for Idiopathic Scoliosis in the United States (2001-2010)

    Final Number:

    Anthony O Asemota MD MPH; Joseph K Canner MHS; Eric B Schneider PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Idiopathic scoliosis (IS) results in significant deformity of the spine and requires corrective spinal fusion surgery (SFS). We sought to describe trends in SFS for IS in the United States.

    Methods: Using ICD-9-diagnostic codes, we queried the 2001-2010 Nationwide Inpatient Sample and identified IS patients (737.30). ICD-9-procedural codes (81.04-81.08) identified SFS procedures which were sub-categorized into: dorsolumbar [DL], lumbosacral [LS], combined dorsolumbar/lumbosacral [DL/LS]; anterior column [AC], posterior column [PC], combined anterior/posterior column [AC/PC]; anterior technique [AT], posterior technique [PT] and combined anterior/posterior techniques [AT/PT].

    Results: Among 983,053 IS patients, 14.3% underwent SFS. Most IS patients were female (76.0%); mean age was 55.7years (Standard-error/SE=0.06). SFS performed were DL=51.4%, LS=41.5%, DL/LS=7.1%; AC=48.7%, PC=39.9%, AC/PC=11.4%, AT=6.6%, PT=81.2%, and AT/PT=12.2%. Analysis of trends from 2001-2010 revealed significant changes in DL from 52.9% to 35.0%, p<0.001, LS (40.2% to 56.4%, p<0.001), DL/LS (6.8% to 8.6%, p<0.001); AC (44.1 % to 44.2% p>0.05), PC (41.8% to 43.0% p<0.05), AC/PC (14.1% to 12.8%, p<0.05); AT (10.7% to 4.8%, p<0.001), PT (75.4% to 81.2%, p<0.001), and AT/PT (13.9% to 14.0%, p>0.05). Overall mortality associated with IS was 1.9%, which decreased from 2.4% to 1.9% from 2001-2010, p<0.001, and was higher among non-surgery vs. surgery group (2.2 vs.0.2%, p<0.001). Mortality in patients that underwent SFS were: [DL=0.2%, LS=0.2%, DL/LS=0.5%, p=0.02]; [AC=0.2%, PC=0.1%, AC/PC=0.5%, p<0.001]; [AT=0.2%, PT=0.2%, AT/PT=0.5%, p=0.002]. Regression analysis adjusted for possible confounders revealed reduced odds of mortality in LS versus DL (Odds-ratios/OR=0.13; 95%Confidence-intervals/CI=0.04-0.46), in females (OR0.31; 95%CI=0.19-0.52), and in =/<18 year-olds (OR0.31; 95%CI=0.14-0.67). Average duration of IS hospitalization was 5.4 days (95%CI=5.3-5.5). Individual mean total charges associated with IS hospitalizations were $41,015 (95%CI=$40,740.73-$41,290.71). Total inpatient charges associated with SFS amounted to approximately $1.7 billion annually.

    Conclusions: There are significant shifts in SFS for IS treatment. The shift from dorsolumbar to lumbosacral surgery is associated with reduced inpatient mortality.

    Patient Care: Understanding ongoing trends in management and outcomes will help to evaluate current practice and inform on the recent updates in the treatment and care of scoliosis patients.

    Learning Objectives: 1. To highlight trends in the surgical management and techniques of corrective surgery for idiopathic scoliosis. 2. To evaluate short-term outcomes of patients undergoing corrective surgery for idiopathic scoliosis.


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