The Spine Journal published an article examining trends in surgical treatment for lumbar degenerative disc disease.
The researchers collected clinical data from the Nationwide Inpatient Sample for patients 18 years or older from 2000 to 2009 who underwent surgical treatment for the primary diagnosis of lumbar/lumbosacral degenerative disc disease. The researchers found:
1. There were 380,305 patients who underwent surgical treatment for lumbar DDD over the nine-year period. All trends varied based on the patient's age and hospital region.
2. The population-adjusted incidence of surgical treatment grew 2.4-fold during the study period.
3. Anterior and posterior lumbar fusion increased three-fold from 2000 to 2009 while posterior lumbar interbody fusion and posterolateral lumbar fusion was up 2.80-fold.
4. Total disc replacement didn't increase significantly over the study period. "Although all fusion procedures significantly increased, TDR did not increase," concluded the study authors. Surgeons have reported difficulty obtaining coverage for disc replacement in the past, but many payers are changing coverage policies and single-level disc replacements will have a Category I CPT code in 2015.
5. The breakdown of procedures performed is:
• Anterior lumbar interbody fusion: 16.8 percent
• PLIF/PLF: 67.9 percent
• APLF: 13.6 percent
• Total disc replacement: 1.8 percent
6. In the Midwestern region, patients were 1.7 times more likely to undergo surgical treatment for lumbar DDD than in the South and Northeast.
7. Total disc replacement was more common for young patients and patients in the Northeastern part of the United States.
8. Patients in the South and older patients were more likely to undergo PLIF/PLF.