Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008-2011.
BACKGROUND
Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized.


METHODS
A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5 % Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines for PSO were introduced in 2008. Patients who had a thoracic and/or lumbar PSO were identified using CPT codes (22206-22208). In order to appropriately interpret trends in PSO use, three comparison groups were identified. Patients who had a diagnosis of adult spine deformity were identified using ICD-9 codes. Patients who had fusion for spine deformity or posterior spine fusion were identified using CPT codes. Differences in annual utilization and demographics between these four groups were then compared.


RESULTS
From the Private Payor database, 199 PSOs were identified with the number of PSOs increasing from 33 in 2008, to 61 in 2011, representing a 185 % increase. From the Medicare data, 102 PSOs were identified, increasing from 13 in 2008 to 32 in 2011, a 246 % increase. In contrast, from both databases, there was minimal to no increase in the incidence of adult spine deformity, fusion for spine deformity or posterior spine fusion over the study time interval.


CONCLUSIONS
Over the study time interval, there was up to a 3.2-fold increase in the utilization of PSOs while the diagnosis of adult spine deformity, fusion for spine deformity and posterior spine fusions had minimal to no increase.
Norton Leatherman Spine Center, 210 East Gray St. Suite 900, Louisville, KY 40202 USA.
Jeffrey L
JL
Gum
Norton Leatherman Spine Center, 210 East Gray St. Suite 900, Louisville, KY 40202 USA.
Leah Y
LY
Carreon
Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8233, St. Louis, MO 63110 USA.
Jacob M
JM
Buchowski
Columbia University Department of Orthopedic Surgery Division of Spinal Surgery, New York - Presbyterian Hospital, The Allen Pavilion, 5141 Broadway, New York, NY 10034 USA.
Lawrence G
LG
Lenke
Norton Leatherman Spine Center, 210 East Gray St. Suite 900, Louisville, KY 40202 USA.
Steven D
SD
Glassman
Administrative claims dataset; Adult spine deformity; Kyphosis; Pedicle subtraction osteotomy; Sagittal alignment; Scoliosis; Spine deformity