Operative fusion of multilevel cervical spondylotic myelopathy

Impact of patient demographics

Shearwood McClelland, Bryan Marascalchi, Peter G. Passias, Themistocles S. Protopsaltis, Anthony K. Frempong-Boadu, Thomas J. Errico

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)133-136
Number of pages4
JournalJournal of Clinical Neuroscience
Volume39
DOIs
StatePublished - May 1 2017

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Factual Databases
Elective Surgical Procedures
Spondylosis
Sex Factors
Cervical Vertebrae
Spinal Fusion
Insurance Coverage
Spinal Cord Diseases
Health Insurance
Demography
Morbidity
Mortality
Insurance

Keywords

  • Cervical spondylotic myelopathy
  • Gender
  • Insurance status
  • Multilevel disease
  • Race

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Operative fusion of multilevel cervical spondylotic myelopathy : Impact of patient demographics. / McClelland, Shearwood; Marascalchi, Bryan; Passias, Peter G.; Protopsaltis, Themistocles S.; Frempong-Boadu, Anthony K.; Errico, Thomas J.

In: Journal of Clinical Neuroscience, Vol. 39, 01.05.2017, p. 133-136.

Research output: Contribution to journalArticle

McClelland, Shearwood ; Marascalchi, Bryan ; Passias, Peter G. ; Protopsaltis, Themistocles S. ; Frempong-Boadu, Anthony K. ; Errico, Thomas J. / Operative fusion of multilevel cervical spondylotic myelopathy : Impact of patient demographics. In: Journal of Clinical Neuroscience. 2017 ; Vol. 39. pp. 133-136.
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abstract = "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.",
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