Appendix A
ICD-9 DIAGNOSIS CODES
Patient records in NTDB admission years 2008-2011 data sets with any of the following
ICD-9 diagnosis codes were included in our study:
 Cervical spine fractures with spinal cord injury (SCI) are represented by ICD-9
diagnosis codes 806.0(0-9), 806.1(0-9).
 Thoracolumbar spine fractures with spinal cord injury (SCI) are represented by
ICD-9 diagnosis codes 806.2(0-9), 806.3(0-9), 806.4, and 806.5.
 Cervical spine fractures without spinal cord injury (SCI) are represented by ICD-9
diagnosis codes 805.0(0-8), 805.1(1-8).
 Thoracolumbar spine fractures without spinal cord injury (SCI) correspond to
ICD-9 diagnosis codes 805.2, 805.3, 805.4, 805.5.
Cervical spine fracture with SCI
"806.00" => "closed fx of C1-C4 cervical vertebra with unspecified SCI",
"806.01" => "closed fx of C1-C4 cervical vertebra with complete lesion of cord",
"806.02" => "closed fx of C1-C4 cervical vertebra with anterior cord syndrome",
"806.03" => "closed fx of C1-C4 cervical vertebra with central cord syndrome",
"806.04" => "closed fx of C1-C4 cervical vertebra with other specified SCI",
"806.05" => "closed fx of C5-C7 cervical vertebra with unspecified SCI",
"806.06" => "closed fx of C5-C7 cervical vertebra with complete lesion of cord",
"806.07" => "closed fx of C5-C7 cervical vertebra with anterior cord syndrome",
"806.08" => "closed fx of C5-C7 cervical vertebra with central cord syndrome",
"806.09" => "closed fx of C5-C7 cervical vertebra with other specified SCI",
"806.10" => "open fx of C1-C4 cervical vertebra with unspecified SCI",
"806.11" => "open fx of C1-C4 cervical vertebra with complete lesion of cord",
"806.12" => "open fx of C1-C4 cervical vertebra with anterior cord syndrome",
"806.13" => "open fx of C1-C4 cervical vertebra with central cord syndrome",
"806.14" => "open fx of C1-C4 cervical vertebra with other specified SCI",
"806.15" => "open fx of C5-C7 cervical vertebra with unspecified SCI",
"806.16" => "open fx of C5-C7 cervical vertebra with complete lesion of cord",
"806.17" => "open fx of C5-C7 cervical vertebra with anterior cord syndrome",
"806.18" => "open fx of C5-C7 cervical vertebra with central cord syndrome",
"806.19" => "open fx of C5-C7 cervical vertebra with other specified SCI"
Cervical spine fracture without SCI
"805.00" => "closed fx of cervical vertebra unspecified level without SCI",
"805.01" => "closed fx of cervical vertebra C1 without SCI",
"805.02" => "closed fx of cervical vertebra C2 without SCI",
"805.03" => "closed fx of cervical vertebra C3 without SCI",
"805.04" => "closed fx of cervical vertebra C4 without SCI",
"805.05" => "closed fx of cervical vertebra C5 without SCI",
"805.06" => "closed fx of cervical vertebra C6 without SCI",
"805.07" => "closed fx of cervical vertebra C7 without SCI",
"805.08" => "closed fx of cervical vertebra multiple levels without SCI",
"805.10" => "open fx of cervical vertebra unspecified level without SCI",
"805.11" => "open fx of cervical vertebra C1 without SCI",
"805.12" => "open fx of cervical vertebra C2 without SCI",
"805.13" => "open fx of cervical vertebra C3 without SCI",
"805.14" => "open fx of cervical vertebra C4 without SCI",
"805.15" => "open fx of cervical vertebra C5 without SCI",
"805.16" => "open fx of cervical vertebra C6 without SCI",
"805.17" => "open fx of cervical vertebra C7 without SCI",
"805.18" => "open fx of cervical vertebra multiple levels without SCI"
Thoracolumbar fracture without SCI
"805.2" => "closed fx of thoracic vertebra without SCI",
"805.3" => "open fx of thoracic vertebra without SCI",
"805.4" => "closed fx of lumbar vertebra without SCI",
"805.5" => "open fx of lumbar vertebra without SCI"
Thoracolumbar fracture with SCI
"806.20" => "closed fx of T1-T6 thoracic vertebra with unspecified SCI",
"806.21" => "closed fx of T1-T6 thoracic vertebra with complete lesion of cord",
"806.22" => "closed fx of T1-T6 thoracic vertebra with anterior cord syndrome",
"806.23" => "closed fx of T1-T6 thoracic vertebra with central cord syndrome",
"806.24" => "closed fx of T1-T6 thoracic vertebra with other specified SCI",
"806.25" => "closed fx of T7-T12 thoracic vertebra with unspecified SCI",
"806.26" => "closed fx of T7-T12 thoracic vertebra with complete lesion of cord",
"806.27" => "closed fx of T7-T12 thoracic vertebra with anterior cord syndrome",
"806.28" => "closed fx of T7-T12 thoracic vertebra with central cord syndrome",
"806.29" => "closed fx of T7-T12 thoracic vertebra with other specified SCI",
"806.30" => "open fx of T1-T6 thoracic vertebra with unspecified SCI",
"806.31" => "open fx of T1-T6 thoracic vertebra with complete lesion of cord",
"806.32" => "open fx of T1-T6 thoracic vertebra with anterior cord syndrome",
"806.33" => "open fx of T1-T6 thoracic vertebra with central cord syndrome",
"806.34" => "open fx of T1-T6 thoracic vertebra with other specified SCI",
"806.35" => "open fx of T7-T12 thoracic vertebra with unspecified SCI",
"806.36" => "open fx of T7-T12 thoracic vertebra with complete lesion of cord",
"806.37" => "open fx of T7-T12 thoracic vertebra with anterior cord syndrome",
"806.38" => "open fx of T7-T12 thoracic vertebra with central cord syndrome",
"806.39" => "open fx of T7-T12 thoracic vertebra with other specified SCI",
"806.4" => "closed fx of lumbar vertebra with SCI",
"806.5" => "open fx of lumbar vertebra with SCI"
Appendix B
ICD-9 PROCEDURE CODES
Our main outcome measure was surgical treatment of the patient’s spinal injury based on ICD-9
procedure codes for treatments rendered during their initial hospitalization. For those patient’s
diagnosed with spine fracture (see appendix A), the ICD-9 procedure codes listed below in bold
qualified as surgical treatment of the patient’s spinal injury.
###############################################################################
#
03.0 - Exploration and decompression of spinal canal structures
#
03.5 - Operations on spinal cord and spinal canal structures
#
78.59 (exclude 78.5(1-8)) - Internal Fixation
#
79.19 (exclude 79.1(1-8)) - Closed Reduction with Internal Fixation
#
79.29 (exclude 79.2(1-8)) - Open Reduction without Internal Fixation
#
79.39 (exclude 79.3(1-8)) - Open Reduction with Internal Fixation
#
79.69 (exclude 79.6(1-8)) - Debridement of Open Fracture
#
79.89 (exclude 79.8(1-8)) - Closed Reduction with Internal Fixation
#
79.99 (exclude 79.9(1-8)) - Other Operation
#
81.0 - Spinal Fusion
#
81.3 - Refusion of Spine
#
81.6 - Other procedures on spine
#
84.5 - Implantation of other musculoskeletal devices and substances (cages, BMP, cement)
#
84.6 - Replacement of spinal disc
#
84.8 - Insertion, replacement and revision of posterior spinal motion preservation device(s)
# 03 = Operations on spinal cord and spinal canal structures
# 03.0 = Exploration and decompression of spinal canal structures
"03.01" => "Removal of foreign body from spinal canal",
"03.02" => "Reopening of laminectomy site",
"03.09" => "Other exploration and decompression of spinal canal",
# 03.09 includes:
#
#
#
#
#
*Decompression laminectomy
*Decompression laminotomy
*Expansile laminoplasty
*Exploration of spinal nerve root
*Foraminotomy
# 03.5 = Operations on spinal cord and spinal canal structures
# [Not included in our study] "03.51" => "Repair of spinal meningocele",
# [Not included in our study] "03.52" => "Repair of spinal myelomeningocele",
"03.53" => "Repair of vertebral fracture",
# 03.53 includes:
#
#
#
Elevation of spinal bone fragments
*Reduction of fracture of vertebrae
Removal of bony spicules from spinal canal
"03.59" => "Other repair and plastic operations on spinal cord structures",
# 03.59 includes:
#
#
#
#
#
#
Repair of:
Diastematomyelia
Spina bifida NOS
*Spinal cord NOS
Spinal meninges NOS
*Vertebral arch defect
# 78 = Other operations on bones, except facial bones
# 78.5 = Internal fixation of bone without fracture reduction
#
4th digit subclassification for 78.5 and 79.1,2,3,6,8,9:
#
0 Unspecified site
#
1 Scapula, clavicle, and thorax (ribs and sternum)
#
2 Humerus
#
3 Radius and ulna
#
4 Carpals and metacarpals
#
5 Femur
#
6 Patella
#
7 Tibia and fibula
#
8 Tarsals and metatarsals
#
#
#
#
9 Other
Pelvic bones
Phalanges (of foot)(of hand)
*Vertebrae
"78.59" => "Internal fixation of bone without fracture reduction, other (pelvic bones,
phalanges, or vertebrae)",
# 79 = Reduction of fracture and dislocation
"79.19" => "Closed reduction with internal fixation, other (pelvic bones,
phalanges, or vertebrae)",
"79.29" => "Open reduction without internal fixation, other (pelvic bones,
phalanges, or vertebrae)",
"79.39" => "Open reduction with internal fixation, other (pelvic bones,
phalanges, or vertebrae)",
"79.69" => "Debridement of open fracture site, other (pelvic bones,
phalanges, or vertebrae)",
"79.89" => "Open reduction of dislocation, other (pelvic bones,
phalanges, or vertebrae)",
# 79.89 includes open reduction (with internal and external fixation devices)
"79.99" => "Unspecified operation of bone injury, other (pelvic bones,
phalanges, or vertebrae)",
# 80 = Incision and excision of joint structures
# 80.5 = Excision, destruction and other repair of intervertebral disc
"80.50" => "Excision or destruction of intervertebral disc, unspecified",
# 80.50 is unspecified as to excision or destruction
"80.51" => "Excision of intervertebral disc",
# 80.51 includes:
#
*Diskectomy
#
*Removal of herniated nucleus pulposus
#
*Level: cervical, thoracic, lumbar (lumbosacral)
#
*That by laminotomy or hemilaminectomy
#
*That with decompression of spinal nerve root at same level
#
(additional pcode required for any concomitant decompression
#
of spinal nerve root at different level from excision site)
# [Not included in our study] "80.53" => "Repair of the annulus fibrosus with graft or prosthesis",
# [Not included in our study] "80.54" => "Other and unspecified repair of the annulus fibrosus",
# 80.9 = Other excision of joint
"80.99" => "Other excision of joint - spine",
# 81 = Repair and plastic operations on joint structures
# 81.0 = Spinal fusion - includes:
#
arthrodesis of spine with bone graft
#
arthrodesis of spine with internal fixation
"81.00" => "Spinal fusion, not otherwise specified",
"81.01" => "Atlas-axis spinal fusion",
# 81.01 includes:
#
#
#
Craniocervical fusion by anterior, transoral, or posterior techniques
C1-C2 fusion by anterior, transoral, or posterior technique
Occiput C2 fusion by anterior, transoral, or posterior technique
"81.02" => "Other cervical fusion, anterior technique",
# 81.02 includes:
#
#
#
Arthrodesis of C2 level or below:
anterior (interbody) technique
anterolateral technique
"81.03" => "Other cervical fusion, posterior technique",
# 81.03 includes:
#
#
#
Arthrodesis of C2 level or below:
posterior (interbody) technique
posterolateral technique
"81.04" => "Dorsal and dorsolumbar fusion, anterior technique",
# 81.04 includes:
#
#
#
Arthrodesis of thoracic or thoracolumbar region:
anterior (interbody) technique
anterolateral technique
"81.05" => "Dorsal and dorsolumbar fusion, posterior technique",
# 81.05 includes:
#
#
#
Arthrodesis of thoracic or thoracolumbar region:
posterior (interbody) technique
posterolateral technique
"81.06" => "Lumbar and lumbosacral fusion, anterior technique",
# 81.06 includes:
#
#
#
#
Anterior lumbar interbody fusion (ALIF)
Arthrodesis of lumbar or lumbosacral region:
anterior (interbody) technique
anterolateral technique
"81.07" => "Lumbar and lumbosacral fusion, lateral transverse process technique",
"81.08" => "Lumbar and lumbosacral fusion, posterior technique",
# 81.08 includes:
#
Arthrodesis of lumbar or lumbosacral region:
#
posterior (interbody) technique
#
posterolateral technique
#
Posterior lumbar interbody fusion (PLIF)
#
Transforaminal lumbar interbody fusion (TLIF)
# 81.3 = Refusion of spine - includes:
#
arthrodesis of spine with bone graft
#
arthrodesis of spine with internal fixation
#
correction of pseudoarthrosis of spine
"81.30" => "Refusion of spine, not otherwise specified",
"81.31" => "Refusion of atlas-axis spine",
# 81.31 includes:
#
Craniocervical fusion by anterior, transoral, or posterior techniques
#
C1-C2 fusion by anterior, transoral, or posterior technique
#
Occiput C2 fusion by anterior, transoral, or posterior technique
"81.32" => "Refusion of other cervical spine, anterior technique",
# 81.32 includes:
#
Arthrodesis of C2 level or below:
#
anterior (interbody) technique
#
anterolateral technique
"81.33" => "Refusion of other cervical spine, posterior technique",
# 81.33 includes:
#
Arthrodesis of C2 level or below:
#
posterior (interbody) technique
#
posterolateral technique
"81.34" => "Refusion of dorsal and dorsolumbar spine, anterior technique",
# 81.34 includes:
#
Arthrodesis of thoracic or thoracolumbar region:
#
anterior (interbody) technique
#
anterolateral technique
"81.35" => "Refusion of dorsal and dorsolumbar spine, posterior technique",
# 81.35 includes:
#
Arthrodesis of thoracic or thoracolumbar region:
#
posterior (interbody) technique
#
posterolateral technique
"81.36" => "Refusion of lumbar and lumbosacral spine, anterior technique",
# 81.36 includes:
#
Anterior lumbar interbody fusion (ALIF)
#
Arthrodesis of lumbar or lumbosacral region:
#
anterior (interbody) technique
#
anterolateral technique
"81.37" => "Refusion of lumbar and lumbosacral spine, lateral transverse process technique",
"81.38" => "Refusion of lumbar and lumbosacral spine, posterior technique",
# 81.38 includes:
#
Arthrodesis of lumbar or lumbosacral region:
#
posterior (interbody) technique
#
posterolateral technique
#
Posterior lumbar interbody fusion (PLIF)
#
Transforaminal lumbar interbody fusion (TLIF)
"81.39" => "Refusion of not elsewhere classified",
# 81.6 = Other procedures on spine
"81.62" => "Fusion or refusion of 2-3 vertebrae",
"81.63" => "Fusion or refusion of 4-8 vertebrae",
"81.64" => "Fusion or refusion of 9 or more vertebrae",
"81.65" => "Percutaneous vertebroplasty",
# 81.65 = Injection of bone void filler (cement)(polymethylmethacrylate)(PMMA)
#
into the diseased or fractured vertebral body
"81.66" => "Percutaneous vertebral augmentation",
# 81.66 = Insertion of inflatable balloon, bone tamp, or other device displacing
#
(removing)(compacting) bone to create a space (cavity)(void) prior
#
to the injection of bone void filler (cement)
#
(polymethylmethacrylate)(PMMA) or other substance
# 81.66 includes:
#
Arcuplasty
#
Kyphoplasty
#
Skyphoplasty
#
Spineoplasty
# 84 = Other procedures on musculoskeletal system
# 84.5 = Implantation of other musculoskeletal devices and substances
"84.51" => "Insertion of interbody spinal fusion device",
# 84.51 = Insertion of cages (carbon, ceramic, metal, plastic or titanium):
#
interbody fusion cage
#
synthetic cages or spacers
#
threaded bone dowels
"84.52" => "Insertion of recombinant bone morphogenetic protein",
# 84.52 = Insertion of rhBMP via collagen sponge, coral, ceramic and
#
other carriers
"84.55" => "Insertion of bone void filler",
# 84.55 = Insertion of:
#
acrylic cement (polymethylmethacrylate)(PMMA)
#
bone void cement
#
calcium based bone void filler
# 84.6 = Replacement of spinal disc
"84.60" => "Insertion of spinal disc prosthesis, not otherwise specified",
"84.61" => "Insertion of partial spinal disc prosthesis, cervical",
"84.62" => "Insertion of total spinal disc prosthesis, cervical",
"84.63" => "Insertion of spinal disc prosthesis, thoracic",
"84.64" => "Insertion of partial spinal disc prosthesis, lumbosacral",
"84.65" => "Insertion of total spinal disc prosthesis, lumbosacral",
"84.66" => "Revision or replacement of artificial spinal disc prosthesis, cervical",
"84.67" => "Revision or replacement of artificial spinal disc prosthesis, thoracic",
"84.68" => "Revision or replacement of artificial spinal disc prosthesis, lumbosacral",
"84.69" => "Revision or replacement of artificial spinal disc prosthesis, not otherwise
specified",
# 84.8 = Insertion, replacement and revision of posterior spinal motion preservation device(s)
"84.80" => "Insertion or replacement of interspinous process device(s)",
# 84.80 includes insertion of:
#
interspinous process decompression device(s)
#
interspinous process distraction device(s)
"84.81" => "Revision of interspinous process device(s)",
"84.82" => "Insertion or replacement of pedicle-based dynamic stabilization device(s)",
"84.83" => "Revision of pedicle-based dynamic stabilization device(s)",
"84.84" => "Insertion or replacement of facet replacement device(s)",
# 84.84 = facet arthroplasty
"84.85" => "Revision of facet replacement device(s)",