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Spinal Fusion for Pediatric Spondylolisthesis: National Trends, Complications, and Short-Term Outcomes
Kavelin Rumalla1, Chester K Yarbrough1, Andrew J Pugely1
1Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
Insights
This study analyzed national trends in pediatric spondylolisthesis (PS) spinal fusion. While anterior-posterior-lateral fusions decreased, costs and complications increased, particularly with decompression and certain surgical approaches.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Health Services Research
Background:
- Current pediatric spondylolisthesis (PS) surgical management relies on limited single-center data.
- A comprehensive understanding of national trends and outcomes is crucial for evidence-based guidelines.
Purpose of the Study:
- To analyze national trends in surgical management for pediatric spondylolisthesis (PS).
- To identify predictors of short-term outcomes in spinal fusion surgery for PS using a large national database.
Main Methods:
- Retrospective cross-sectional analysis of the Kids' Inpatient Database (KID) from 2003-2012.
- Inclusion of pediatric patients (age 5-17) undergoing spinal fusion for PS (n=2646).
- Analysis of procedural trends, patient characteristics, and short-term outcomes using univariate and multivariable analyses.
Main Results:
- Posterior-only fusions (PSF) were most common (86.8%), while anterior-posterior-lateral fusions (APLF) decreased significantly (9.9% to 6.4%).
- Trends showed increased Medicaid insurance, use of bone morphogenetic protein-2, decompression, and inflation-adjusted hospital costs.
- Medicaid status, teaching hospitals, decompression, and APLF procedures were associated with increased complication likelihood.
Conclusions:
- The addition of decompression and APLF procedures correlated with higher in-hospital complications, potentially indicating greater surgical complexity.
- Significant decrease in APLF utilization observed, alongside a notable increase in treatment costs for pediatric spondylolisthesis over the study period.
Background:
Current surgical management guidelines for pediatric spondylolisthesis (PS) are reliant on data from single-center cohorts.
Objective:
To analyze national trends and predictors of short-term outcomes in spinal fusion surgery for PS by performing a retrospective cross-sectional analysis of the Kids' Inpatient Database (KID).
Methods:
The KID (sampled every 3 yr) was queried from 2003 to 2012 to identify all cases (age 5-17) of spinal fusion for PS (n = 2646). We analyzed trends in patient characteristics, surgical management, and short-term outcomes. Both univariate and multivariable analyses were utilized.
Results:
The 2646 spinal fusions for PS included posterior-only fusions (86.8%, PSF), anterior lumbar interbody fusions (4.8%, ALIF), and combined anterior and posterior fusions (8.4%, APLF) procedures. The utilization of APLF decreased over time (9.9%-6.4%, P = .023), whereas the number of total spinal fusions and the proportion of PSF and ALIF procedures have not changed significantly. Uptrends in Medicaid insured individuals (1.2%-18.9%), recombinant human bone morphogenetic protein-2 insertion (8.8%-16.6%), decompression (34.7%-42.8%), and mean inflation-adjusted hospital costs ($21 855-$32 085) were identified (all P < .001). In multivariable analysis, Medicaid status (odds ratio [OR] = 1.93, P = .004), teaching hospitals (OR = 1.94, P = .01), decompression (OR = 1.78, P = .004), and the APLF procedure (OR = 2.47, P = .001) increased the likelihood of complication occurrence (all P < .001).
Conclusion:
The addition of decompression during fusion and the APLF procedure were associated with more in-hospital complications, though this may have been indicative of greater surgical complexity. The utilization of the APLF procedure has decreased significantly, while costs associated with the treatment of PS have increased over time.
