Spinal Surgery Varies by Region in U.S.: Study

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Surgery for low back pain caused by spinal stenosis varies depending on where in the United States you live, a new report says.

“Nearly 80 percent of Americans will experience low back pain at some point in their lives, and about 30 million people a year receive professional medical care for a spine problem,” co-author Brook Martin, of the Dartmouth Institute of Health Policy & Clinical Practice, said in a college news release.

In spinal stenosis, thickening of tissue surrounding the spine affects the spinal nerves, resulting in pain, according to background information in the study. Treatments include surgery, medication, physical therapy and steroid injections, the study said.

The two types of surgery for spinal stenosis are spinal decompression and spinal fusion, according to the researchers, who explain that in spinal decompression, doctors remove the tissue compressing the spinal nerves. In spinal fusion, surgeons join two or more vertebrae to stabilize the spine.

Spinal fusion has a higher risk of infection and readmission to the hospital, and there is no evidence that it provides greater benefit to patients, according to the news release. Even so, its use increased 67 percent among Medicare patients from 2001 to 2011 and it’s now more common than spinal decompression, the researchers said.

The study’s analysis of Medicare data revealed that rates of spinal decompression varied eightfold across the United States, from about 25 procedures per 100,000 patients in Bronx, N.Y., to nearly 217 procedures per 100,000 patients in Mason City, Iowa. In general, rates of spinal decompression were highest in the Pacific Northwest and northern Mountain states.

Rates of spinal fusion varied more than 14-fold nationally, from about 9 procedures per 100,000 patients in Bangor, Maine, to about 127 procedures per 100,000 patients in Bradenton, Fla., according to the Dartmouth Atlas Project report.

“It is critical that we fully inform patients of the risks as well as potential benefits through a collaborative process between patients and physicians of shared decision making,” Martin said.

Surgery is irreversible, Martin said. “Using shared decision-making encourages the exchange of information so as to optimize results,” he said.

More information

The American College of Rheumatology has more about spinal stenosis.

Source: HealthDay

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