Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

Presented at the 2009 Joint AANS/CNS Spine Section Meeting

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The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period.


Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool.


Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006.


During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.

Abbreviations used in this paper: LOS = length of stay; NIS = Nationwide Inpatient Sample; SCI = spinal cord injury.

Article Information

Address correspondence to: Fernando L. Vale, M.D., Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, Florida 33606. email:

© AANS, except where prohibited by US copyright law.



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    Graphs. Discharge status from 1997 to 2006 in patients with cervical spine fractures without SCI (upper) and with SCI (lower).

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    Hospitalizations in SCI and non-SCI groups from 1997 to 2006.

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    Length of stay in SCI and non-SCI groups from 1997 to 2006.

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    Hospital charges in SCI and non-SCI groups from 1997 to 2006.

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    In-house mortality rates in SCI and non-SCI groups from 1997 to 2006.

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    Discharges to skilled nursing facility (SNF) in SCI and non-SCI groups from 1997 to 2006.

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    Routine discharges in SCI and non-SCI groups from 1997 to 2006.



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