Background: Cervical spine injury, with or without spinal cord
injury, is an important cause of morbidity and mortality in the United States.
While substantial regional variation has been shown in per capita rates of
elective cervical spine surgery, similar data regarding arthrodesis rates for
traumatic cervical injury have not been reported, to our knowledge. We
assessed the rates of cervical spinal arthrodesis for patients who had a
cervical spine injury with or without an associated spinal cord injury.
Methods: The data for the present study came from the Healthcare
Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2002.
International Classification of Diseases, Ninth Revision, Clinical
Modification codes were used to identify patients with a cervical vertebral
fracture or dislocation with or without an associated spinal cord injury.
Hospitals were grouped according to their teaching status, location (urban or
rural), and volume of cervical spine injury patients. The rates of spinal
arthrodesis and halo/tong placement were compared for patients within each
Results: Twenty-eight thousand, five hundred and eighteen patients
with a cervical spine injury were analyzed. Spinal arthrodesis was performed
for 16.5% of patients who had a cervical fracture without an associated spinal
cord injury, for 50.4% of patients who had a cervical spine fracture with an
associated spinal cord injury, and for 44.1% of patients who had a cervical
dislocation. With the numbers available, the rates of arthrodesis for patients
who had a fracture without a spinal cord injury and for patients who had a
cervical dislocation were not significantly different between high and
low-volume centers, although the rate for patients who had a cervical fracture
with a spinal cord injury was significantly higher at high-volume hospitals.
The rates of arthrodesis did not vary significantly between urban teaching and
nonteaching hospitals, with the numbers available, for patients in any of the
three diagnostic categories. Individual hospitals had a threefold to fivefold
variation in the arthrodesis rate for patients with a cervical spine injury,
depending on the diagnostic category.
Conclusions: The present study demonstrated substantial differences
in the rate of arthrodesis for patients with cervical spine trauma, depending
on the diagnostic category. The variations in the rates of arthrodesis within
diagnostic categories appear to be lower than the previously reported
variation in the rates of elective cervical spine procedures.