Your Chance of having spine surgery may depend on where you live.

Your Chance of having  spine surgery may depend on where you live.

Your Chance of having spine surgery may depend on where you live.

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As a practicing Spine Surgeon for more than 20 years,  I have had the great honor of witnessing tremendous changes in my field.  During my residency training in the late 1980’s,  spine surgery was about to begin a tremendous technology change. As we are now in 2015,  Newer,  safer,  faster diagnostic testing such as MRI’s,  water soluble myelogram dyes,  became mainstream.  Medications for nerve irritation came to market.  Traditional large surgical incisions are giving way to more targeted,  smaller,  incisions.  Despite all these changes,  the prime goals of spine surgery still remains the same.  If there is compression of a nerve or spinal cord,  the goal is to provide more room for that nerve.  If the spine segments move abnormally,  the surgical goal is to stabilize the movement or to restore the normal movement.

Because of the advance of technology,  and greater emphasis on clinical guidelines and protocols,   most would think that the rationale for surgery would also be the same amongst different surgeons,  and therefore the rates of surgery in any community would be similar.  Unfortunately,  that conclusion has been definitely proven wrong.

In 2014,  the Dartmouth Atlas of Healthcare  it says “This Dartmouth Atlas of Health Care series reports on unwarranted regional variation in the care of several conditions for which surgery is one important treatment option. Unwarranted variation is the differences in care that are not explained by patient needs or preferences.”     To translate this statement into everyday terms,  different medical communities have different rates of surgical procedure frequency.  The different rates is not explained purely based on medical needs.

The Atlas of Spinal Stenosis Surgery used Fee for Service Medicare recipient data for each community.  This is data available, and collected by the US Government,  and represents the numbers of spinal stenosis surgery procedures performed in a location amongst the medicare population.   Certainly there will be some variation in some of the health factors among the compared communities,  but in general,  it is the over 65 aged population,  with those who have renal failure or diasbility prior to age 65.

The variations in the frequency of the surgery was significant.

RAW DATA:

SPINAL STENOSIS SURGERY (Decompression only,  no fusion)

From 2001 to 2011,  in the USA,  the rate of spinal stenosis surgery was 80 surgeries per 100,000 fee for service medicare recipients.

In the communities of  Bronx  NY,   Miami Florida,  and South Bend Indiana,  there was less than 35 surgeries per 100k.

In the communities of  Mason City Iowa, Tacoma Washington, and Bloomington Illinois,  the rate was around 200 surgeries per 100k.

 

LUMBAR FUSION SURGERY

From 2001 to 2011,  in the USA, the rate of lumbar spinal fusion for stenosis was 41.1 per 100k fee for service Medicare recipients.

In Bangor Maine,  the rate of inpatient lumbar spinal fusion was 9.2 per 100k Medicare recipients.

In Bradenton Florida,  the rate of the same fusions was 127.5 per 100k Medicare recipients.

There are many examples of different communities with significant differing rates of lumbar spinal stenosis fusion surgeries.  These large variations cannot be explained by the clinical needs of the patient.

 

DATA DIFFERENCES BETWEEN 2001 AND 2011

Between the two dates, the rate of Spinal stenosis decompression only surgery was reduced by more than 50%

At the same time,  the rate of spinal fusion with decompression increased by 67%

2011 patients with spinal stenosis were much more likely to get a lumbar fusion along with a decompression procedure than in 2001.

Unfortunately,  despite the great utilization of spinal fusion operations,  there has not been any significant measurable clinical advantage (from a population standpoint)  from the addition surgical procedures.

 

The Spinal Stenosis Surgery Atlas demonstrates wide variation in the rates of surgery.  While the decision for surgery is an individual one made by the Patient and the Surgeon,  from a bird’s eye view,  they must be other reasons besides pure clinical indications that will explain this variety.   With all the concerns about the costs of healthcare,  and population health management,  this is yet another data set that suggests the need for a more integrated,  value centric approach to managing Government sponsored healthcare benefits.

 

Citations

  • Ryskina KL, Halpern SD, Minyanou NS, Goold SD, Tilburt JC. The role of training environment care intensity in US physician cost consciousness. Mayo Clin Proc. 2015 Mar;90(3):313-20. PubMed PMID: 25633153

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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