Spotlight on Research 2010

August 2010 (historical)

Complex Lower Back Surgeries in U.S. Elderly on the Rise

Researchers funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) have identified an increase in the rate of complicated surgical procedures for lower back pain in the elderly. Their study, published in a recent issue of the Journal of the American Medical Association (JAMA), also found that – when compared with simpler approaches – the more complex procedures were linked to a higher rate of serious surgical complications and health care costs.

Richard Deyo, M.D., of Oregon Health and Science University, and scientists at other institutions, analyzed Medicare records from 2002–2007 for patients with lumbar spinal stenosis, a narrowing of the spine in the lower back, and degenerative spondylolisthesis, a forward slipping of one of the bones (vertebrae) of the spine on top of another. Both conditions are caused by wear and tear of the intervertebral disc, the gel-like tissue found between the vertebrae. And, both conditions are a common cause of lower back pain in older adults.

The investigators focused on three surgical approaches for these conditions – decompression (the simplest approach, in which part of the bone that is putting pressure on the spinal nerves is removed); simple fusion (binding two or three vertebrae together, either from the front or the back); and complex fusion (binding more than three vertebrae together, or fusing both the front and the back, and often involving hardware and supplemental therapies, such as molecules known as biologics). When compared with the number of procedures performed in 2002, the rates of decompressions and of simple fusions had decreased slightly by 2007, whereas complex fusions increased 15-fold during the same period.

Complex fusions were also associated with more serious complications – such as pneumonia, pulmonary embolism and heart attack – and were linked to hospital costs that were three times more than hospital charges for decompression alone. Deyo and his team could not explain why the more complex procedures were on the rise, but speculate that “the introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications.”

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’ National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at

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Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010 Apr 7; 303(13):1259-65.