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Epidemiology and safety of spinal instrumentation surgery in Japan: A report from Japanese spinal instrumentation
Haruki Ueda1, Hideyuki Arima2, Koji Yamada3
1Department of Orthopaedic Surgery, Dokkyo Medical University, Japan; Committee of the Database, Japanese Spinal Instrumentation Society, Japan.
Background:
Spinal instrumentation surgery has seen improvements in safety and invasiveness thanks to technological innovations such as navigation systems, robotics, and improved implants, and its indications have expanded. This, combined with an increase in patients from aging population, has led to a global rise in surgical cases, particularly in countries with aging societies. However, Japan previously lacked a nationwide registry, making it difficult to fully understand the epidemiological trends of these surgeries. To address this, the Japanese Society of Spinal Instrumentation (JSIS) developed the web-based, multi-institutional case registration database (JSIS-DB) in 2018.
Methods:
This study analyzed 32,656 confirmed cases registered in the first- and second-generation JSIS-DB between 2018 and 2022. Patient background, implants used, and complications were statistically compared across age groups and surgical procedures. Statistical analysis included Chi-square tests, Wilcoxon rank-sum tests, and logistic regression analysis were used for intergroup comparisons.
Results:
Regional disparities were observed with a notable concentration of registered cases in metropolitan areas. Patient age showed a bimodal distribution peaking in the teens and seventies. Two-thirds of procedures used posterior approaches. Minimally invasive techniques were significantly more frequent in elderly patients. Revision surgeries showed higher complication rates and more frequent cases without implant use. Systemic and psychiatric complications significantly increased with age. The proportion of patients aged 90 or older undergoing surgery showed a significant annual increase of 0.13 % (p = 0.014).
Conclusions:
This study presents the first analysis of spinal instrumentation surgery in Japan using a nationwide registry. The results revealed that surgical procedures are being selected based on age and risk factors, ranging from children to the super-elderly. Moving forward, appropriate surgical selection and perioperative management in a super-aged society will become increasingly important. The JSIS-DB is expected to play a significant role as a foundation for future quality improvement and clinical research.
