Sharp Increase in Spinal Surgery Among Medicare Patients Shows Decreased Benefits

Procedures: Sharp Rise in Complex Back Surgery Among Older Adults

The percentage of older adults undergoing a complicated fusion procedure for the painful lower-back condition called spinal stenosis has increased steeply, rising fifteenfold from 2002 to 2007, a new study reports.

Researchers said the increase was leading to higher Medicare costs and more life-threatening complications. They noted that although the overall rate of all types of surgery for spinal stenosis fell slightly during the five-year period, the proportion undergoing complex fusion increased to 19.9 per 100,000 Medicare beneficiaries, up from 1.3.

In the complex surgery, more than three vertebrae are fused and both the back and the front of the vertebrae are involved. Alternative procedures are decompression — removal of part of the bone pressing on the nerve — and simple fusion, in which two or three vertebrae are fused and only the front or the back of the vertebrae is involved.

The complex procedure costs almost four times as much as decompression and is associated with three times the rate of life-threatening complications, according to the study.

Earlier studies have not found that the complex surgery leads to better results or greater pain relief, said Dr. Richard A. Deyo, a professor of family and internal medicine at Oregon Health and Science University in Portland and the lead author of the study, published April 7 in The Journal of the American Medical Association.

To read the entire study, go to JAMA---->

Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults
Richard A. Deyo, MD, MPH; Sohail K. Mirza, MD, MPH; Brook I. Martin, MPH; William Kreuter, MPA; David C. Goodman, MD, MS; Jeffrey G. Jarvik, MD, MPH


JAMA. 2010;303(13):1259-1265.