VARIATION IN THE RATE OF CERVICAL-SPINE SURGERY IN WASHINGTON-STATE

Lack of consensus about the treatment of low back pain is reflected by wide regional variations in lumbar spine surgery rates. Neck pain may be as common as low back pain, but there has been no similar evaluati on of regional variation for the surgical treatment of neck pain. This report examines the geographic variation and temporal trends in the r ate of cervical spine surgery in Washington state from 1986 through 19 89. Using diagnosis and procedure codes from the International Classif ication of Diseases (ICD-9 CM), the authors retrospectively identified cervical spine surgery cases from a statewide hospital discharge regi stry for Washington. After excluding cases associated with trauma, inf ection, or malignancy, 5,173 incident cervical spine surgery cases wer e analyzed. Cervical spine surgery was performed at approximately 25% the rate of lumbar spine surgery, and from 1986 to 1989, the age- and gender-adjusted rate increased 20%. Small area analysis demonstrated a sevenfold variation among counties in the rate of cervical spine surg ery (P < 0.001), with variation of fourfold to 13-fold for specific su rgical procedures. These data demonstrate that cervical spine surgery for neck pain is an increasingly common procedure with wide geographic variability. Rational treatment of neck pain requires further definit ion of indications for cervical spine surgery, preferably based on fir m data concerning the outcomes of surgical and nonsurgical care.