University of Oulu

Kotkansalo, A., Leinonen, V., Korajoki, M. et al. Surgery for degenerative cervical spine disease in Finland, 1999–2015. Acta Neurochir 161, 2147–2159 (2019).

Surgery for degenerative cervical spine disease in Finland, 1999–2015

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Author: Kotkansalo, Anna1,2,3; Leinonen, Ville4,5; Korajoki, Merja3;
Organizations: 1Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, PB 52, 20521, Turku, Finland
2Faculty of Medicine, Department of Clinical Medicine, University of Turku, Turku, Finland
3Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
4Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
5Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland and Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
6Department of Orthopedics, Helsinki University Hospital, Helsinki, Finland
7Welfare District of Forssa, Forssa, Finland
8Orton Orthopaedic Hospital, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2020-03-06


Background: The incidence of surgery for degenerative cervical spine disease (DCSD) has risen by almost 150% in the USA in the last three decades and stabilized at slightly over 70 operations/100,000 people. There has been significant regional variation in the operation incidences. We aim to assess the diagnosis-based, age-adjusted trends in the operation incidences and the regional variation in Finland between 1999 and 2015.

Methods: Data from the Finnish Hospital Discharge Register (FHDR), the Cause of Death Register, and the registers of the Social Insurance Institution were combined to analyze all the primary operations for DCSD or rheumatoid atlanto-axial subluxation (rAAS). Combinations of the operative and the diagnosis codes were used to classify the patients into five diagnostic groups.

Results: A total of 19,701 primary operations were included. The age-adjusted operation incidence rose from 21.0 to 36.5/100,000 people between 1999 and 2013 and plateaued thereafter. The incidence of surgery for radiculopathy increased from 13.1 to 23.3 operations/100,000 people, and the incidence of surgery for DCM increased from 5.8 to 7.0 operations/100,000 people. The rise was especially pronounced in surgery for foraminal stenosis, which increased from 5.3 to 12.4 operations/100,000 people. Of the five diagnostic groups, only operations for rAAS declined. Operations increased especially in the 40- to 65-year-old age group. The overall operation incidences varied from 18.3 to 43.1 operations/100,000 people between the university hospitals.

Conclusions: The age-adjusted incidence of surgery for DCSD has risen in Finland by 76%, but the rise has plateaued. Surgery for radiculopathy, especially for foraminal stenosis, increased more steeply than surgery for degenerative medullopathy, with vast regional differences in the operation incidences.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 161
Pages: 2147 - 2159
DOI: 10.1007/s00701-019-03958-6
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
Funding: The Hospital District of Helsinki and Uusimaa has granted the study group and the responsible investigator State research funding through the Orton Research Foundation (grant number 9310/403). The corresponding author has received a personal research grant from the Finnish Medical Foundation (Eka-apuraha, 2016). Open access funding provided by University of Turku (UTU) including Turku University Central Hospital.
Copyright information: © Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.