The Business of Spinal Fusions
Spinal fusions are big business in the United States. In 2013, over 87% of the surgical spinal procedures involved a fusion. The US performs over double the amount of yearly fusions compared to Canada, the United Kingdom, Western Europe, and Australia. Nearly 500,000 fusion are being performed this year (nearly 250,000 were performed in 2001).
Are these procedures providing superior outcomes for our patients? It would appear the answer is no.
In 2006, a Medicare physicians panel found that “it was less than reasonably likely that spinal fusion would provide a long-term benefit for patients suffering from degenerative disc disease.” Medicare never translated this finding into their policies, however, other insurers have picked up on the fact that spinal fusion utilization may be far greater than its effectiveness.
Blue Cross & Blue Shield has now excluded spinal fusion as a covered procedure for degenerative disc disease without gross instability. They recommend at least 3 months of conservative spine care. Cigna also has a similar recommendation. Even the International Society for the Advancement of Spine Surgery said “increasing success and optimism may be leading some surgeons to overuse procedures beyond what the current state of medical evidence really supports.” Also of note is between 2006-2009 the cost of a spinal fusion nearly doubled. This is in part due to the surgical implant companies increasing the pricing of instrumentation.
Many health care facilities are building multidisciplinary health care centers. These spine centers include medical doctors, chiropractors, and other allied health practitioners. Preliminary data shows that these spine centers are providing a higher quality of care, with great patient satisfaction, good outcomes, and a model of care based on best practice and evidence based guidelines for spine care. Whether or not a spinal fusion is right for you is a decision to be made between you and your doctor. However, growing evidence would suggest that conservative spine care may be more effective for many individuals.