Thoracic disc disorders with myelopathy: Treatment trends, patient characteristics, and complications

Study Design: Retrospective review.

Objective: To analyze trends in the use of 3 surgical treatments (anterior/anterolateral decompression and spinal fusion [ASF], posterior/posterolateral decompression and spinal fusion [PSF], and disc decompression/excision without fusion [DDE]) for patients with thoracic disc disorders with myelopathy (TDM), and how the treatments differ in terms of patient and hospital characteristics, complications, mortality, and resource utilization.

Summary of Background Data: Various approaches have been described in the literature, but the preferred method is not well established.

Methods: Using the Nationwide Inpatient Sample database, we identified 13,837 patients with TDM who underwent spine surgery from 2000 through 2010. Analyses were performed using linear regression for trends, χ² test for categorical variables, and analysis of variance test for discrete variables (significance, P < 0.05).

Results: Over the study period, the preferred treatment of TDM shifted substantially from DDE being performed in two-thirds of the patients in 2000 to PSF being performed in almost half of all patients by 2010. Patients undergoing ASF were significantly younger and had significantly higher rates of private insurance than those in the other groups. DDE was performed significantly more frequently at nonteaching hospitals. Patients undergoing ASF had the highest complication rate (24.2%), especially pulmonary and cardiac complications. They also had a 2.8-fold and 2.0-fold mortality compared with DDE and PSF, respectively. Patients undergoing DDE had significantly shorter length of stay and lower total hospitalization charges than the other groups.

Conclusion: Over the last decade, there has been a significant increase in PSF use in the surgical treatment of TDM. Postoperative complication and mortality rates were highest with ASF; DDE approach was associated with significantly fewer complications, shorter length of stay, and lower hospitalization charges than other groups.