Variation in the rate of cervical spine surgery in Washington state

Douglas Einstadter, Daniel L. Kent, Stephan D. Fihn, Richard (Rick) Deyo

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluation of regional variation for the surgical treatment of neck pain. This report examines the geographic variation and temporal trends in the rate of cervical spine surgery in Washington state from 1986 through 1989. Using diagnosis and procedure codes from the International Classification of Diseases (ICD-9 CM), the authors retrospectively identified cervical spine surgery cases from a statewide hospital discharge registry for Washington. After excluding cases associated with trauma, infection, or malignancy, 5,173 incident cervical spine surgery cases were analyzed. Cervical spine surgery was performed at approximately 25% the rate of lumbar spine surgery, and from 1986 to 1989, the age- and gender-adjusted rate increased 20%. Small area analysis demonstrated a sevenfold variation among counties in the rate of cervical spine surgery (P <0.001), with variation of fourfold to 13-fold for specific surgical procedures. These data demonstrate that cervical spine surgery for neck pain is an increasingly common procedure with wide geographic variability. Rational treatment of neck pain requires further definition of indications for cervical spine surgery, preferably based on firm data concerning the outcomes of surgical and nonsurgical care.

Original languageEnglish (US)
Pages (from-to)711-718
Number of pages8
JournalMedical Care
Volume31
Issue number8
StatePublished - 1993
Externally publishedYes

Fingerprint

surgery
Spine
pain
Neck Pain
International Classification of Diseases
Low Back Pain
regional difference
Small-Area Analysis
Registries
trauma
indication
Consensus
incident
Therapeutics
Disease
firm
lack
gender
Wounds and Injuries
trend

Keywords

  • Cervical spine surgery
  • Neck pain
  • Small area analysis

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Einstadter, D., Kent, D. L., Fihn, S. D., & Deyo, R. R. (1993). Variation in the rate of cervical spine surgery in Washington state. Medical Care, 31(8), 711-718.

Variation in the rate of cervical spine surgery in Washington state. / Einstadter, Douglas; Kent, Daniel L.; Fihn, Stephan D.; Deyo, Richard (Rick).

In: Medical Care, Vol. 31, No. 8, 1993, p. 711-718.

Research output: Contribution to journalArticle

Einstadter, D, Kent, DL, Fihn, SD & Deyo, RR 1993, 'Variation in the rate of cervical spine surgery in Washington state', Medical Care, vol. 31, no. 8, pp. 711-718.
Einstadter, Douglas ; Kent, Daniel L. ; Fihn, Stephan D. ; Deyo, Richard (Rick). / Variation in the rate of cervical spine surgery in Washington state. In: Medical Care. 1993 ; Vol. 31, No. 8. pp. 711-718.
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