Disparities in anterior cervical discectomy and fusion provision and outcomes for cervical stenosis

North American Spine Society Journal, 2023 · DOI: https://doi.org/10.1016/j.xnsj.2023.100217 · Published: April 14, 2023

Surgery Spinal Disorders Public Health

Simple Explanation

This study examines how social and economic factors affect who gets surgery for a narrowed spinal canal in the neck (cervical stenosis) and how well they do after surgery. It looks at things like race, income, and insurance to see if they play a role in getting the surgery (ACDF) and the risk of problems afterward. The findings suggest that poorer patients and certain racial groups may face more advanced disease before getting treatment and have a higher chance of complications.

Study Duration

2016-2019

Participants

155,300 patients undergoing ACDF

Evidence Level

Not specified

Key Findings

1
White patients were less likely to have severe symptoms like myelopathy, while Black and Hispanic patients were more likely to experience these symptoms.
2
Patients with Medicaid or Medicare were more likely to have advanced disease before the surgery.
3
Patients in the highest income group consistently had better outcomes than those in the lowest income group.

Research Summary

Significant disparities exist in the trajectory of cervical stenosis (CS) and the risks associated with anterior cervical discectomy and fusion (ACDF) amongst various demographic cohorts. Lower socioeconomic status (SES) demonstrated consistent associations with more advanced degenerative spine disease, less favorable outcomes, and increased healthcare resource utilization (HRU) in our cohort of patients with CS undergoing anterior surgery. Certain populations face a greater risk of serious adverse outcomes such as sepsis, tracheostomy, and AKI that not only affect the trajectory of recovery but also greatly increase HRU and decrease patient quality of life and satisfaction.

Practical Implications

Equitable Distribution of Care

Findings call for active systemic solutions to increase the equitable distribution of neurosurgical care.

Early Intervention

Promote early intervention for prevention of disease progression, especially in vulnerable populations.

Risk-Based Assessments

Integrate the synergistic effects of sociodemographic factors into risk-based assessments to provide individualized care.

Study Limitations

1
Retrospective study design limits establishing causal relationships.
2
Database analyses are subject to inter-hospital variation in coding.
3
Median income based on zip code may not completely reflect a patient’s financial status.

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