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National trends in orthopedic surgical procedures among adults with spina bifida: A MarketScan database study
Haad A Arif1, Emilio Feijoo1, Ellie Starnes1
1Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Adults with spina bifida (SB) experience significant orthopedic procedures, particularly casting, strapping, and wound care, indicating ongoing skin issues. These findings highlight the need for specialized adult care and interventions for long-term mobility challenges.
Area of Science:
- Orthopedics
- Epidemiology
- Adult Health
Background:
- Spina bifida (SB) incidence reduced by prenatal screening and folic acid.
- Increased life expectancy for individuals with SB due to multidisciplinary care.
- Limited research on orthopedic outcomes in adults with SB.
Purpose of the Study:
- To describe the epidemiology of orthopedic procedures in adults with spina bifida.
- To identify common orthopedic interventions and their frequencies in this population.
Main Methods:
- Utilized the MarketScan database to analyze orthopedic procedures in adults with SB.
- Assessed Current Procedural Terminology codes for orthopedic procedures and upper extremity nerve decompressions.
Main Results:
- 10,869 adults with SB (average age 38.1 years, 58.6% female) were analyzed.
- Most common procedures included multi-layer compression, Unna boot application, and SI joint injections.
- 37.1% underwent casting/strapping; 4.4% had lower extremity amputations; 1.8% had joint arthroplasty.
Conclusions:
- Adults with SB face a high burden of casting, strapping, and wound care procedures, suggesting persistent skin breakdown issues.
- Sacroiliac joint injections were common; arthroplasty and nerve decompression indicate long-term sequelae of altered gait and assistive device use.
Background:
Prenatal screening and folic acid supplementation have decreased spina bifida (SB) incidence, while advances in multidisciplinary care have increased life expectancy for those born with the condition. Historically, orthopedic outcomes research has focused largely on childhood, as earlier assumptions regarding limited survival into adulthood contributed to the exclusion of adults with SB from longitudinal studies. As a result, knowledge of orthopedic procedures performed on adults with SB may help to guide treatment in childhood and transition to adult care.
Objective:
To describe the epidemiology of orthopedic procedures performed on adults with SB.
Methods:
The MarketScan database was queried to investigate the frequency of orthopedic procedures among adults with SB. All orthopedic Current Procedural Terminology codes were assessed, as were codes for upper extremity nerve decompression procedures.
Results:
A total of 10,869 adults with SB were included. Patients were, on average, 38.1 years ± 14.5 old and female (58.6 %). Patients most commonly underwent application of multi-layer compression below the leg (12.1 %), Unna boot application (6.7 %), and sacroiliac (SI) joint injections (4.7 %). Over one-third (n = 4,036, 37.1 %) of patients underwent casting/strapping procedures. Joint arthroplasty was observed in 1.8 % of patients while lower extremity amputations occurred in 4.4 % of patients. Nerve decompressions (n = 210, 1.9 %) were the most common upper extremity procedures followed by arthroscopic shoulder surgery (n = 151, 1.4 %).
Conclusion:
Adults with SB underwent a notable burden of casting/strapping and procedures related to wound care, representing ongoing problems with skin breakdown. Injection of the SI joint was a common procedure. Joint arthroplasty, rotator cuff repair, and nerve decompression, while less frequent, may demonstrate both the long-term sequelae of altered gait mechanics and the upper extremity consequences of prolonged use of assistive mobility devices.
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