University of Oulu

Kotkansalo, A., Malmivaara, A., Korajoki, M. et al. Surgical techniques for degenerative cervical spine in Finland from 1999 to 2015. Acta Neurochir 161, 2161–2173 (2019).

Surgical techniques for degenerative cervical spine in Finland from 1999 to 2015

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Author: Kotkansalo, Anna1,2,3; Malmivaara, Antti3,4; Korajoki, Merja3;
Organizations: 1Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, PB 52, 20521 Turku, Finland
2Faculty ofMedicine, Department of ClinicalMedicine, University of Turku, Turku, Finland
3Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
4Orton Orthopaedic Hospital, Helsinki, Finland
5Welfare district of Forssa, Forssa, Finland
6Unit of Clinical Neuroscience, Neurosurgery, University of Oulu and Medical Research Center, Oulu University Hospital, Oulu, Finland
7Institute of Clinical Medicine – Neurosurgery, University of Eastern Finland, Kuopio, Finland
8Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
Persistent link:
Language: English
Published: Springer Nature, 2019
Publish Date: 2020-03-09


Purpose: The purpose of this study is to assess the trends and regional variations in the operative techniques used for degenerative or rheumatoid cervical spine disease in Finland between 1999 and 2015.

Methods: The Finnish Hospital Discharge Register (FHDR) was searched for the data on all the primary operations for degenerative cervical spine disease (DCSD) or rheumatoid atlanto-axial subluxation (rAAS). Operative codes were used to identify the patients from the FHDR and combined with diagnosis codes to verify patient inclusion. The patients were classified into three groups: anterior cervical decompression and fusion (ACDF), posterior decompression and fusion (PDF) and decompression.

Results: A total of 19,701 primary operations were included. The adjusted incidence of ACDF rose from 6.5 to 27.3 operations/100,000 adults. ACDF became the favoured technique in all the diagnostic groups except AAS, and by 2015, ACDF comprised 84.5% of the operations. The incidence of PDF for DCSD increased from 0.2 to 0.7/100,000 people. Solely decompressive operations declined from 13.7 to 4.0 operations/100,000 people. The regional differences in the incidence of operations were most marked in the incidence of ACDF, with overall incidences ranging from 11.2 to 37.0 operations/100,000. The distribution of the operative techniques used varied as well.

Conclusions: Between 1999 and 2015, the operative techniques used for DCSD changed from prevalently decompressive to utilising ACDF in 68.8 to 91.0% of the operations, depending on the treating hospital. ACDF became the most commonly applied technique for all degenerative diagnoses except AAS.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 161
Issue: 10
Pages: 2161 - 2173
DOI: 10.1007/s00701-019-04026-9
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
Funding: Open access funding provided by University of Turku (UTU) including Turku University Central Hospital. 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). The sponsors had no role in the design or conduct of this research.
Copyright information: © The Author(s) 2019.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.