Study design: Literature review.
Objectives: To assess the frequency of lumbar fusion procedures in the United States; changes in the incidence of fusion in the past 12 years; variations in fusion procedure rates among geographic regions of the nation and between the United States and other countries; costs of lumbar fusion; and rates of infrequent outcomes, which are best estimated from administrative data, including complications and deaths.
Summary of background data: Several recent analyses have shown that lumbar spine fusion procedures are done more frequently and are associated with increased costs and rates of complications.
Methods: Qualitative review of the literature on frequency, costs, and complications of lumbar fusion.
Results and conclusions: The rates of lumbar fusion procedures are increasing rapidly, particularly for lumbar spinal stenosis in older patients. Fusion rates appear to vary markedly among individual surgeons, among small and large geographic regions in the nation, and between the United States and England. These variations are considerably more dramatic than variations in rates of lumbar discectomy. Fusion for spinal stenosis with spondylolisthesis is, as expected, associated with higher costs and complication rates than is decompressive surgery for this indication without fusion. Fusion rates are increasing rapidly and show dramatic geographic variations, suggesting differences in opinion within the surgical community regarding the appropriate indications for lumbar fusion. Studies are needed to determine whether the frequency, costs, and complications of lumbar fusion are justified by clinical benefits.