title: Trends of Posterior Long Segment Fusion with and without Recombinant Human Bone Morphogenetic Protein 2 in Patients with Scoliosis.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  Symptomatic scoliosis can be a source of severe pain and disability. When nonoperative treatments fail, spine fusion is considered as an effective procedure in scoliosis management. The purpose of this study was to evaluate the trends of patients with scoliosis undergoing posterior long segment fusion (PLSF) with and without recombinant human bone morphogenetic protein 2 (rhBMP-2).
  
  
  METHODS
  Patients within the orthopedic subset of Medicare database undergoing PLSF from 2005 to 2011 were identified using the PearlDiver Patient Records Database. Both diagnosis and procedural International Classification of Diseases, ninth edition and Current Procedural Terminology codes were used. The year of procedure, age, sex, region, and rhBMP-2 use were recorded.
  
  
  RESULTS
  In total, 1,265,591 patients with scoliosis were identified with 29,787 PLSF surgeries between 2005 and 2011. The incidence of PLSF procedures increased gradually from 2005 to 2009, decreased in 2010 (p < 0 0.01), and grew again in 2011. Patients over age 84 years had the highest incidence of PLSF. The lowest incidence of the procedures was in the Northeast, 5.96 per 100,000 patients. Sex differences were observed with a male-to-female ratio of 0.40 (p < 0.01). The use of rhBMP-2 for PLSF increased steadily from 2005 to 2009; the numbers dropped dramatically in 2010 and returned by 2011.
  
  
  CONCLUSIONS
  According to our study, patients with scoliosis demonstrated a 0.6575 average incidence increase of PLSF treatments annually. There were significant differences in incidence of PLSF procedure and patient demographics. Additionally, rhBMP-2 consumption significantly changed when we stratified it by sex, age, and region respectively.
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States; Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, ChangChun City, JiLin Province, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Ruofeng
authors.affiliation: Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California, United States.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Cohen
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Buser
authors.affiliation: Department of Orthopedics, Emory Spine Center, Atlanta, Georgia, United States.
authors.forename: S Tim
authors.initials: ST
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany.
authors.forename: Hans-Joerg
authors.initials: HJ
authors.lastname: Meisel
authors.affiliation: Durango Orthopedic Associates, P.C./Spine Colorado, Durango, Colorado, United States.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Youssef
authors.affiliation: Department of Orthopaedic Surgery, Uijongbu St. Mary's Hospital, The Catholic University of Korea School of Medicine, Uijongbu, Korea.
authors.forename: Jong-Beom
authors.initials: JB
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, United States.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah, United States.
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
keywords: PLSF; PearlDiver; age; region; retrospective study; rhBMP-2; scoliosis; sex