Abstract / Summary
BackgroundDegenerative cervical myelopathy (DCM) is the leading non-traumatic cause of spinal cord dysfunction in adults, and its burden is projected to grow as populations age. Cervical radiculopathy shares the same degenerative substrate but follows a separate diagnostic pathway. Long-term national trends in the two conditions, and their relation to surgical practice, are unquantified in an East Asian system with universal coverage.MethodsThis nationwide repeated cross-sectional ecological analysis used aggregate open data from the Korean Health Insurance Review and Assessment Service, 2010 through 2024. DCM was identified by ICD-10 codes M50.0 and M47.1, cervical radiculopathy by M50.1, and ossification of the posterior longitudinal ligament by M48.8; fee codes identified surgical volumes. Rates are annual diagnostic prevalence (unique patients per code per year) and were age-standardized to the World Health Organization World Standard Population. Joinpoint regression quantified average annual percent change (AAPC), and four sensitivity analyses addressed case definition, care setting, coding era, and the March 2022 extension of magnetic resonance imaging reimbursement.ResultsThe DCM age-standardized rate fell from 147.2 to 83.7 per 100,000, a decline of 43.1 percent (AAPC −4.14 percent, 95 percent confidence interval [CI] −4.63 to −3.65, p < 0.001); the corresponding crude patient count fell 15.7 percent, whereas cervical radiculopathy rose from 697.9 to 851.9 (AAPC +1.34 percent, 95 percent CI +1.08 to +1.59). Total cervical procedure volume did not increase significantly (12,167 to 13,613; AAPC +0.60 percent, p = 0.078), but its composition shifted: posterior cervical fusion rose 105.5 percent and laminoplasty 120.8 percent, whereas anterior cervical discectomy and fusion changed little. The posterior share rose from 14.4 to 27.6 percent (AAPC +4.93 percent, 95 percent CI +4.53 to +5.34).ConclusionThe DCM age-standardized rate fell 43.1 percent over 15 years (crude patient count, 15.7 percent) while cervical radiculopathy rose, yet cervical surgical volume did not fall and laminoplasty more than doubled. The declining diagnosis rate is more consistent with a change in coding than with a decreasing burden of disease, and these estimates provide a baseline for surveillance of cervical spinal cord disease under universal coverage.