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)",