Matthew Thomas Carr

Study Design: Retrospective cohort study. Objective: This study aimed to forecast national trends in anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) through 2035 in the US Medicare population using comprehensive, procedure-specific modeling approaches. Summary of Background Data: Cervical spinal fusion is widely performed for degenerative cervical spine disease. ACDF remains the most common procedure, while PCF is indicated for multilevel disease, deformity, and revision cases. Despite the high-utilization, up-to-date, procedure-specific forecasts for the Medicare population are lacking. Updated forecasts are required to guide workforce planning, policy development, and resource allocation for an aging population. Methods: National Medicare Part B data were analyzed from 2005 to 2022 to identify ACDF and PCF procedures using Current Procedural Terminology (CPT) codes. Procedure volumes were adjusted for Medicare Advantage enrollment. Ordinary least squares (OLS) regression models were developed to project volumes through 2035, excluding data from 2020 and 2021 to minimize bias from COVID-19-related disruptions. Model performance was assessed using R ² , slope estimates, and 5-fold cross-validation. Results: Estimated ACDF volumes increased from 57,765 in 2011 to 101,019 in 2022. ACDF volumes are projected to increase to about 170,102 procedures by 2035 (95% CI: 139,912–200,291). Estimated PCF volumes increased from 9659 in 2005 to 42,400 in 2022 and are projected to reach 68,901 procedures by 2035 (95% CI: 66,108–71,693). The models demonstrated strong fit for both procedures (ACDF R ² =0.8382, PCF R ² =0.9892). Conclusions: National volumes of cervical spinal fusion are expected to continue rising through 2035 among Medicare beneficiaries. These trends likely reflect an aging population, broader surgical indications, and the continued shift toward outpatient spine surgery. Our findings have important implications for surgical workforce needs, reimbursement policy, and resource allocation across inpatient and ambulatory care settings.

Study Design: Retrospective cohort study. Objective: This study aimed to determine how decompressive lumbar laminectomy (DLL) procedure volumes changed after the publication of major randomized controlled trials (RCTs) that investigated the clinical efficacy of DLL. Summary of Background Data: Two RCTs published in 2015 and one published in 2018 demonstrated no benefit of DLL compared with nonoperative care in intention-to-treat analyses. However, it remains unclear how these RCTs have influenced clinical practice. Methods: After conducting a systematic literature review to identify major DLL RCTs, we analyzed DLL volumes in an aggregated data set that contains Medicare Part B procedure data from 2013 to 2023. Results: Throughout 2013 to 2023, normalized DLL procedure volumes generally decreased. Before the 2015 RCTs, the slope of the normalized DLL procedure volumes was −0.22, which then decreased to −0.26 after 2015 ( P P <0.0001). Conclusions: Normalized DLL procedure volumes generally decreased from 2013 to 2023, but the rate of decline accelerated after the publication of two RCTs in 2015 and decelerated after the publication of the 2018 RCT. Therefore, although clinical practice trends aligned directionally with the evidence, the magnitude and consistency of response to high-level evidence varied over time. Level of Evidence: Level IV.

Study Design: Retrospective cohort study. Objective: This study aimed to determine how kyphoplasty and vertebroplasty procedure volumes, specialty-specific usage, and payments have changed among the Medicare patient population from 2015 to 2023. Summary of Background Data: Vertebral augmentation procedures, specifically kyphoplasty and vertebroplasty, are used to treat vertebral compression fractures. Published studies have found kyphoplasties to be associated with lower rates of cement leakage and more favorable postoperative vertebral alignment, including improved local kyphotic angle. Methods: We used an aggregated data set that contains Medicare Part B procedure data at the physician level from 2015 to 2023 (n=1819 unique physicians total). We filtered for kyphoplasty and vertebroplasty Current Procedural Terminology codes, and then analyzed overall trends in procedure volume, payment, and specialty usage over time. We used statistical tests to identify differences in these parameters between kyphoplasty and vertebroplasty. Results: From 2015 to 2023, the total number of both kyphoplasty and vertebroplasty procedures decreased with a compound annual growth rate (CAGR) of −5.4% and −16.8%, respectively. In 2019, 2020, 2022, and 2023, there were more kyphoplasty procedures than vertebroplasty procedures ( P P <0.0001). The average payment amount for kyphoplasties slightly increased overall from 2015 to 2023, with a CAGR of 6.9%. Although previous studies have identified similar trends up until 2018, our study provides an updated understanding. Conclusions: Our analysis of a comprehensive Medicare data set found that kyphoplasties are more common than vertebroplasties, and the use of both procedures has decreased slightly over time. Diagnostic and interventional radiology both perform a large proportion of these procedures. Level of Evidence: Level IV.

Injury to the recurrent laryngeal nerve (RLN) during anterior cervical discectomy and fusion and/or total disc replacement (ACDF/TDR) is a relatively uncommon yet impactful sequela. Should the RLN ...

Study Design: Retrospective cohort study. Objective: Our objective was to compare postoperative opioid prescriptions between male and female patients after anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). Summary of background data: Sex differences in pain are well-established in basic science and clinical medicine; however, sex differences in postoperative pain management after spine surgery are less well-studied. Methods: The Marketscan Commercial Claims and Encounters database was queried for adults without a history of chronic opioid use who underwent ACDF or CDA from January 2017 through June 2021. Binary logistic regression analyses of filling an opioid prescription and generalized linear model analyses of total oral morphine milligram equivalents (MMEs) prescribed were performed. “Perioperative” prescription were defined as 30 days before to 14 days after surgery; “prolonged postoperative” was defined as 91 to 180 days after surgery. Results: For single-level ACDF (n=9844; 51.7% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.36; 95% CI: 1.18, 1.56; P P =0.02]. For multilevel ACDF (n=12,871; 52.5% female), females were more likely to fill a prolonged postoperative prescription [aOR: 1.16; 95% CI: 1.03, 1.30; P =0.02] and filled lower MMEs than males in the perioperative period [AMD: −27.47; 95% CI: −39.78, −15.17; P P =0.002], but there was no association between sex and perioperative or prolonged postoperative MME. Conclusions: These findings can guide the expectations on postoperative opioid prescribing after ACDF/CDA and warrant further studies to confirm the results and optimize postoperative pain management. Level of Evidence: Level III.

Objective To identify predictors for time to first treatment modality (TTT) in patients diagnosed with spinal metastatic disease. Methods Our radiology database was retrospectively queried to identify patients with spinal metastases (01/2017-12/2021). Demographics, setting of initial imaging (inpatient/outpatient/ED), histology, treatment modality, and TTT were collected. Several different early TTT thresholds were explored (≤ 30, ≤ 21, ≤14, and ≤ 7 days). After controlling for age, gender, diagnostic setting, pathology, type of treatment multivariable linear and logistic regressions were performed for the primary and secondary thresholds at different time-points. Results A total of 1009 patients with spinal metastases were included, with a median age of 65 years (IQR 15) and 529 (52.4%) males. Diagnoses occurred in the inpatient (37%), outpatient (50%), and emergency department (13%) settings. The most common primary tumors were breast (22.4%), prostate (19.5%), and non-small cell lung cancer (12.8%). Treatment modalities included surgery (14.6%), chemotherapy (54.5%), and radiation therapy (43.5%). The median time to treatment (TTT) was 13 days (SD 27, range 0–676), with no significant difference by setting (p = 0.2). In multivariable linear regression, surgery was associated with shorter TTT (p = 0.037). Logistic regression using different early-TTT thresholds identified age, surgical intervention, lymphoma, and outpatient setting as significant predictors across models. Sensitivity analyses excluding TTT outliers showed that surgery was no longer a significant predictor, while other covariates remained stable. Conclusions Surgical intervention and lymphoma independently predicted earlier TTT of any modality in spinal metastases, whereas older age and outpatient diagnosis were associated with delays.