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Background: Recent studies show increases in cervical spine surgery prevalence and cervical spondylotic myelopathy (CSM) diagnoses in the US. However, few studies have examined outcomes for CSM surgical management, particularly on a nationwide scale., Objective: Evaluate national trends from 2001 to 2010 for CSM patient surgical approach, postoperative outcomes, and hospital characteristics., Methods: A retrospective nationwide database analysis provided by the Nationwide Inpatient Sample (NIS) including CSM patients aged 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty from 2001 to 2010. Patients with fractures, 9+ levels fused, or any cancer were excluded. Measures included demographics, hospital data, and procedure-related complications. Yearly trends were analyzed using linear regression modeling., Results: 54,348 discharge cases were identified. ACDF, posterior only, and combined anterior/posterior approach volumes significantly increased from 2001 to 2010 (98.62%, 303.07%, and 576.19%; respectively, p<0.05). However, laminoplasty volume remained unchanged (p>0.05). Total charges for ACDF, posterior only, combined anterior/posterior, and laminoplasty approaches all significantly increased (138.72%, 176.74%, 182.48%, and 144.85%, respectively; p<0.05). For all procedures, overall mortality significantly decreased by 45.34% (p=0.001) and overall morbidity increased by 33.82% (p=0.0002). For all procedures except ACDF, which saw a significantly decrease by 8.75% (p<0.0001), length of hospital stay was unchanged., Conclusions: For CSM patients between 2001 and 2010, combined surgical approach increased sixfold, posterior only approach increased threefold, and ACDF doubled; laminoplasties without fusion volume remained the same. Mortality decreased whereas morbidity and total charges increased. Length of stay decreased only for ACDF approach. This study provides clinically useful data to direct future research, improving patient outcomes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: This is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications., Materials and Methods: Retrospective review of the Nationwide Inpatient Sample 2001-2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9years] vs. adolescent [10-18year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality., Results: 6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p<0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p<0.001), cardiac (OR 0.27, p<0.001), respiratory (OR 0.26, p<0.001), digestive system (OR 0.32, p<0.001), puncture nerve/vessel (OR 0.56, p=0.009), wound (OR 0.25, p<0.001), infection (OR 0.29, p<0.001), posthemorrhagic anemia (OR 0.04, p=0.002), ARDS (OR 0.13, p<0.001), and venous thrombotic (OR 0.53, p=0.043) complications. Detethering increased nervous system (OR 1.34, p=0.049) and urinary (OR 2.60, p<0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p<0.001), LOS (5.77 vs. 4.13days, p<0.001), and charges ($54,592.28 vs. $33,043.83, p<0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p<0.001) than pediatric., Conclusions: With fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in patients older than age 55, with operative management being a widely adopted approach. Previous work has shown that private insurance status, gender and patient race are predictive of the operative approach patients receive (anterior-only, posterior-only, combined anterior-posterior). The Nationwide Inpatient Sample from 2001 to 2010 was used to assess the potential role of multilevel CSM as a contributing factor in determining which operative approach CSM patients receive, as it is rare for an anterior-only approach to be sufficient for CSM patients requiring fusion of four or more involved levels. Multivariate analyses revealed that female sex (OR=3.78; 95% CI=2.08-6.89; p<0.0001), private insurance (OR=5.02; 95% CI=2.26-11.12; p<0.0001), and elective admission type (OR=4.12; 95% CI=1.65-10.32; p=0.0025) were predictive of increased receipt of a 3+ level fusion in CSM. No other variables, including patient age, race, income, or admission source were predictive of either increased or decreased likelihood of receiving fusion of at least three levels for CSM. In conclusion, female sex, private insurance status, and elective admission type are each independent predictors in CSM for receipt of a 3+ level fusion, while patient age, race and income are not. Given the propensity of fusions greater than three levels to require posterior approaches and the association between posterior CSM approaches and increased morbidity/mortality, these findings may prove useful as to which patient demographics are predictive of increased morbidity and mortality in operative treatment of CSM., (Copyright © 2016 Elsevier Ltd. All rights reserved.)