Trends and Variations in Cervical Spine Surgery in the United States

Medicare Beneficiaries, 1992 to 2005

Degenerative changes to the spine are very common in people over 55, and spinal surgery rates are increasing. Studies have shown increases of up to 90 percent in surgeries for this condition in the general adult U.S. population between 1990–2000. The authors used a retrospective cohort study to examine population-based trends in variations in surgeries for degenerative spinal conditions in older people, a population in which this condition has not been extensively studied.

This study relied on data from Medicare patients over 65 who underwent spinal surgeries between 1992–2005. The authors’ analyses showed a 206 percent increase in cervical spine fusion surgeries in this population, with enormous variation in rates for this procedure by geographic location. States varied from each other in surgical rates, with the South having the highest rates in general. While the authors note the difficulty of determining a “right” amount of such surgeries to be performed, the geographical variation points to inconsistencies as to when these surgeries are performed. Also of note are the recent findings of a Cochrane review of the literature showing that, a year after treatment, patients undergoing cervical spondylotic radiculomyelopathy did not have significantly better outcomes than patients undergoing medical treatment.

This research suggests several important areas for further investigation. Studies illuminating the efficacy and complications associated with spinal surgeries should be done. Also, the high variation in geographic factors associated with these surgeries suggests that indications for such procedures need to be more clearly defined and more consistently implemented.