Spinal stenosis treatment trends: Fewer surgeries, more complex procedures

The frequency of surgeries for lumbar spinal stenosis among Medicare recipients decreased slightly between 2002 and 2007, but the use of complex procedures increased substantially. A greater risk of medical complications and a higher mortality rate resulted.

Deyo and coworkers conducted a retrospective cohort analysis of Medicare claims to examine trends in the use of various surgical procedures. Patients 65 years or older with a primary diagnosis of lumbar spinal stenosis were selected. Three categories of spine surgery were defined: decompression, simple fusion, and complex fusion. Complications in 3 categories were considered: major medical complications, wound complications, and mortality.

The adjusted rate of lumbar stenosis surgery per 100,000 Medicare beneficiaries was 135.5 in 2007, down from 137.4 in 2002. However, the rate of complex fusion procedures climbed from 1.3 to 19.9 per 100,000 beneficiaries, a 15-fold increase. Complex fusion operations were associated with a 5.2% rate of major medical complications compared with 2.1% for decompression alone.

The authors noted that the increase in complex procedures may be explained by the introduction of new surgical devices, belief among surgeons that more aggressive interventions result in better outcomes, and improvements in surgical and anesthetic technique and supportive care.