National trends in orthopedic surgical procedures among adults with spina bifida: A MarketScan database study.

BACKGROUND

Prenatal screening and folic acid supplementation have decreased spina bifida (SB) incidence, while advances in multidisciplinary care have increased life expectancy for those born with the condition. Historically, orthopedic outcomes research has focused largely on childhood, as earlier assumptions regarding limited survival into adulthood contributed to the exclusion of adults with SB from longitudinal studies. As a result, knowledge of orthopedic procedures performed on adults with SB may help to guide treatment in childhood and transition to adult care.

OBJECTIVE

To describe the epidemiology of orthopedic procedures performed on adults with SB.

METHODS

The MarketScan database was queried to investigate the frequency of orthopedic procedures among adults with SB. All orthopedic Current Procedural Terminology codes were assessed, as were codes for upper extremity nerve decompression procedures.

RESULTS

A total of 10,869 adults with SB were included. Patients were, on average, 38.1 years ± 14.5 old and female (58.6 %). Patients most commonly underwent application of multi-layer compression below the leg (12.1 %), Unna boot application (6.7 %), and sacroiliac (SI) joint injections (4.7 %). Over one-third (n = 4,036, 37.1 %) of patients underwent casting/strapping procedures. Joint arthroplasty was observed in 1.8 % of patients while lower extremity amputations occurred in 4.4 % of patients. Nerve decompressions (n = 210, 1.9 %) were the most common upper extremity procedures followed by arthroscopic shoulder surgery (n = 151, 1.4 %).

CONCLUSION

Adults with SB underwent a notable burden of casting/strapping and procedures related to wound care, representing ongoing problems with skin breakdown. Injection of the SI joint was a common procedure. Joint arthroplasty, rotator cuff repair, and nerve decompression, while less frequent, may demonstrate both the long-term sequelae of altered gait mechanics and the upper extremity consequences of prolonged use of assistive mobility devices.