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Nationwide Trends in the Surgical Management of Lumbar Spinal Stenosis

Bae, Hyun W., MD*,†; Rajaee, Sean S., MS†,‡; Kanim, Linda E., MA*,†

doi: 10.1097/BRS.0b013e3182833e7c
Health Services Research

Study Design. Retrospective analysis using national administrative data.

Objective. This study presents US nationwide trends in the surgical management of patients with lumbar spinal stenosis (LSS) with and without coexisting spondylolisthesis and scoliosis from 2004 to 2009.

Summary of Background Data. Lack of consensus and wide variability exists in surgical decision making for patients with LSS.

Methods. Data were obtained from the Nationwide Inpatient Sample, a database developed as part of the Healthcare Cost and Utilization Project. All discharged patients with a primary diagnosis of LSS were identified. Three subgroups were studied: (1) LSS alone, (2) LSS with spondylolisthesis, and (3) LSS with scoliosis. Surgical treatment was divided into 3 groups: (1) decompression only (laminectomy, discectomy), (2) simple fusion (1–2 disc levels, single approach), and (3) complex fusion (>2 disc levels or a combined posterior and anterior approach).

Results. Between 2004 and 2009, national estimates for the annual number of discharged inpatients with a primary diagnosis of LSS increased from 94,011 (population rate, [the age adjusted population rate per 100,000] 32.1) to 102,107 (population rate, 33.3). The rate of decompressions decreased from 58.5% to 49.2% for discharged patients with LSS from 2004 to 2009 (P < 0.05), whereas the rate of simple fusions increased from 21.5% to 31.2% (P < 0.05) and the rate of complex fusions did not change at 6.7%. From 2004 to 2009, the use of bone morphogenetic protein more than doubled from 14.5% to 33.0% of all fusions, and the use of interbody devices increased from 28.5% to 45.1% (P < 0.05). In 2009, 26.2% of patients with LSS without instability underwent a fusion procedure, while 82.7% of patients with LSS with coexisting spondylolisthesis and 67.6% of patients with coexisting scoliosis underwent a fusion procedure.

Conclusion. This study demonstrates that the rate of simple fusion surgery has increased for treatment of LSS compared with decompression only.

Level of Evidence: 4

This study presents US nationwide trends in the surgical management of patients with lumbar spinal stenosis. From 2004 to 2009, the rate of decompressions decreased, whereas simple fusions increased and complex fusions did not change. Additionally, the use of bone morphogenetic protein and interbody devices increased significantly.

*Cedars Sinai Spine Center, Los Angeles, CA

Spine Research Foundation, Santa Monica, CA; and

Tufts University School of Medicine, Boston, MA.

Address correspondence and reprint requests to Hyun W. Bae, MD, Spine Research Foundation, 2811 Wilshire Blvd Ste 850, Santa Monica, CA 90403; E-mail:

Acknowledgment date: March 1, 2012. First revision date: October 23, 2012. Second revision date: December 11, 2012. Acceptance date: December 11, 2012.

Hyun Bae and Sean Rajaee should be considered as co-first authors for this study as both authors contributed equally and took leadership in this study.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, payment for lectures, and royalties.

© 2013 by Lippincott Williams & Wilkins