A questionable increase: Complex spinal fusion surgeries soar


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In just five years, from 2002 to 2007, the number of complex fusion surgeries to treat spinal stenosis of the lower back soared from a rate of 1.3 per 100,000 to 19.9 per 100,000, according to a study released Tuesday in the Journal of the American Medical Assn. Complex spinal fusion involves joining several vertebrae and can also include removing disks, bone or bone spurs.

During that same time period, the rates of decompression surgery (relieving pressure on the spine) and simple fusion procedures (joining just one or two vertebrae) decreased. The study was done among Medicare recipients.


Stenosis is a condition in which the spinal canal narrows and compresses the spinal cord and nerves. It is not a simple thing to either correctly diagnose or treat. Studies show that decompression surgery is often beneficial over doing nothing. However, more complex surgeries are increasingly preferred by physicians, and these surgeries carry more risk. The study showed that complications occurred in 2.3% of patients having decompression alone to 5.6% in patients having complex spinal fusions. Patients who had complex fusion had three times the rate of life-threatening complications, had longer hospitalizations and higher rates of re-hospitalization.

Finally, there is the money. Complex fusion operations cost, on average, $80,888 in hospital charges compared with $23,724 for decompression.

In an editorial accompanying the study, Dr. Eugene J. Carragee of Stanford University cautions patients to compare decompression with other treatments, which may be unproven. But, he notes, the income generated by the more complex surgeries can make it difficult for patients to receive a ‘careful assessment’ of all of the alternatives.

-- Shari Roan