Effect of Changes Over Time on Trends in Neck FusionBenjamin Franklin was credited with saying, In this world nothing can be said to be certain, except death and taxes. But there is one more thing that could be added: change. Whether it occurs quickly or slowly, change is a constant in our lives. This is especially true in the world of medicine.
Medications change, procedures change, treatment methods change, and so on. In the field of orthopedic surgery, length of hospital stays are shorter, surgical tools and techniques are improved, and the kinds of patients who qualify for surgical procedures have been expanded.
In this article, national trends in anterior cervical decompression and fusion (ACDF) are reported. ACDF is one of the most common surgical spine procedures in the U.S. Whenever a treatment approach becomes popular, it is considered a good idea to observe results carefully and see if that popularity is warranted.
In this procedure, the surgeon makes an incision in the anterior (front) of the neck, performs a discectomy (removes the disc) and fuses the two vertebrae together. A fusion simply means that two bones grow together.
Usually, when two vertebrae are fused together, a small piece of bone called a bone graft is inserted between the two vertebrae where the disc has been removed. This bone graft serves to both separate the vertebrae and to stimulate the two bones to grow together - or fuse. The fusion procedure usually involves the use of hardware, such as screws, plates, or cages to keep the bones from moving.
To evaluate the performance of this procedure, we ask: Is the procedure having the intended effect? Are the outcomes successful? Who can benefit and are there other people out there who could really use this treatment? Is it safe and effective for all age groups, both sexes (male and female), and for each diagnosis for which it was used?
Right now, anterior cervical decompression and fusion (ACDF) is favored for degenerative disc disease. It is fairly easy to perform, patients recover quickly, and studies from the 1990s show good results overall. But that data is already over 10 years old. What are the current trends?
Using data collected by the Centers for Disease Control and Prevention (CDC) as part of the National Hospital Discharge Survey, the following trends were observed:
The authors of this report say that these changes represent a significant trend in patient care and utilization of health care. Results remain good-to-excellent with fewer complications than ever before.
Better technology, improved surgical techniques. and safer anesthesia means that patients with other health problems can have this surgery. That's compared with 15 years ago when their diabetes, obesity, high blood pressure, heart disease or other condition would have meant no surgery.
Not only that, but it looks like better medications has gained improvements in pain control. Postoperative physical therapy has speeded up recovery and reduced the length of hospital stay.
What's the benefit of knowing national trends in anterior cervical fusion procedures? Just one word: planning. This information helps hospital administrators, health care professionals, and researchers map out future studies and treatment.
Everything is fluid and constantly changing in the medical world. The effect of changes over time on trends in surgeries like the widely used anterior cervical decompression and fusion (ACDF) procedure will effect who can be treated with this surgery.
The information helps give patients a better idea what to expect regarding potential complications and recovery. And hospital business managers know how much of the hospital staff and resources will be dedicated to the diagnosis and treatment of cervical spine degeneration in all age groups.
Satyajit Marawar, MD, et al. National Trends in Anterior Cervical Fusion Procedures. In Spine. July 1, 2010. Vol. 35. No. 15. Pp. 1454-1459.
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