Surgery for Lumbar Degenerative Disc Disease Increased by 2.4-fold in the Last Decade

Peer Review by Todd Albert, MD

Peer Reviewed

Surgical treatment of lumbar/ lumbosacral degenerative disc disease increased by 2.4-fold between 2000 and 2009, according to data from a nationwide, population-based cohort published in the October 1 issue of The Spine Journal. Trends differed by age group and region of the United States.
Examining data on a laptop computerThe authors retrospectively analyzed national hospital discharge data collected as part of the Nationwide Inpatient Sample from 2000 to 2009. The sample included 380,305 patients aged ≥18 who underwent surgical treatment for lumbar/lumbosacral degenerative disc disease (DDD).

Posterior Lumbar Interbody Fusion/Posterolateral Lumbar Fusion Was the Most Common Surgery Type
The incidence of surgery for lumbar/lumbosacral DDD increased from 21,223 in 2000 to 55,467 in 2009 (P<0.001). Of the 380,305 surgeries performed, posterior lumbar interbody fusion/posterolateral lumbar fusion (PLIF/PLF) was the most common (258,206 patients; 67.9%) followed by anterior lumbar interbody fusion (63,853 patients; 16.8%), anterior and posterior lumbar fusion (51,552 patients; 13.6%), and total disc replacement (6,694 patients; 1.8%).

Population adjusted incidence of surgery for DDD increased 2.4-fold over time—from 7.5 per 100,000 in 2000 to 18.1 per 100,000 in 2009 (P<0.001). As shown in the Table, the incidence of anterior lumbar interbody fusion increased the most (3.1-fold increase) over time followed by PLIF/PLF (2.8-fold increase). In contrast, the incidence of total disc replacement did not increase significantly over time.

Table. Population Adjusted Incidence of Surgical Treatment for Lumbar/lumbosacral Degenerative Disc Disease by Type of Surgery

Geographic Variability in Trends Found
Surgical treatment for lumbar DDD differed by geographic region. Compared with the Northeast region of the United States, this surgery was 1.8 times more common in the Midwest region and 1.7 times more common in the South region. Other variations included a greater frequency of total disc replacement in younger patients and patients in Northeast regions, while PLIF/PLF was more common in older patients and in the South region.

Peer Review by Todd Albert, MD
Surgeon-In-Chief and Medical Director
Korein-Wilson Professor of Orthopedic Surgery
Hospital for Special Surgery
New York, NY

This article reaffirms the increase in spinal surgery and fusion surgery that has been an ongoing trend for over a decade. We need to be clear that this likely does not represent an increase in incidence of disease as is suggested by the authors but rather an increase in decision/recommendation for surgery.

Equally troubling is the disparity in regional variation in rate of surgery and types of surgery. While this variation does not mean that there is a correct rate, it likely implies our (the spine community’s) lack of evidence and clear indications for surgery. It behooves us to perform better research to define the indications and the outcomes so that we can continue the best care to those patients who need it.

Updated on: 02/09/17
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Todd J Albert, MD
This article reaffirms the increase in spinal surgery and fusion surgery that has been an ongoing trend for over a decade. We need to be clear that this likely does not represent an increase in incidence of disease as is suggested by the authors but rather an increase in decision/recommendation for surgery. Equally troubling is the disparity in regional variation in rate of surgery and types of surgery. While this variation does not mean that there is a correct rate, it likely implies our (the spine community’s) lack of evidence and clear indications for surgery. It behooves us to perform better research to define the indications and the outcomes so that we can continue the best care to those patients who need it.
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