Epidemiology and treatment trends in cervical, thoracic and lumbar disc herniation- a nationwide analysis

Degenerative disc herniations are a major contributor to neurological disability and healthcare utilization. However, nationwide data on temporal demographic trends and treatment patterns in cervical and thoracolumbar disc herniation remain limited. This study aimed to analyze long-term epidemiological and treatment trends in Germany over a 10-year period.

This retrospective population-based study analyzed nationwide hospital discharge data from the German Federal Statistical Office between 2014 and 2023. Patients hospitalized with cervical disc herniation (CDH; ICD-10-GM M50.+) or thoracolumbar disc herniation (TLDH; M51.+) were included. Demographic characteristics, hospitalization rates, treatment procedures, comorbidities, and temporal trends were evaluated descriptively and stratified by diagnosis category.

A total of 1,495,546 inpatient cases were identified, including 1,254,674 TLDH cases (83.9%) and 240,872 CDH cases (16.1%). The most affected age group was 45-60 years, with a slight male predominance. Since 2018, a demographic shift toward older patients was observed, with the proportion of individuals aged ≥80 years increasing from 2.1% in 2014 to 4.4% in 2023. Hospitalization rates declined substantially after 2020. Mean length of stay decreased from 6.0 to 4.5 days for TLDH and from 7.1 to 5.2 days for CDH. Injection-based therapies declined markedly, whereas operative volumes remained comparatively stable. The most frequent comorbidities were hypertension, diabetes mellitus, and coronary artery disease across both cohorts throughout.

Hospitalizations for CDH and TLDH declined over time, while the proportion of elderly patients increased considerably. The COVID-19 pandemic temporarily reduced hospitalization rates, and hospital stays shortened substantially, reflecting ongoing structural changes in spine care.