An article published in the Sept.1 issue of Spine examines fusion technique for degenerative spondylolisthesis.
The researchers examined the American Board of Orthopaedic Surgery database to identify patients who underwent spinal fusion for degenerative spondylolisthesis from 1999 until 2011. The patients underwent uninstrumented fusion, fusion with posterior instrumentation, fusion using an interbody device or decompression without fusion.
There were 5,639 cases included in the study. Here are five observations:
1. The number of cases annually doubled during the 10 years studied.
2. Interbody fusion cases increased significantly from 13.6 percent in 1999 to 32 percent in 2011. "Despite little evidence guiding treatment strategy for [degenerative spondylolisthesis], the national treatment patterns have changed dramatically during the past 13 years," concluded study authors.
3. Degenerative spondylolisthesis cases treated with a posterolateral fusion were highest in 2003 and then decreased as the interbody fusion rate increased.
4. The rate of posterolateral fusion and poasterolateral fusion with interbody fusion were nearly identical in 2011. The posterolateral fusion rate was 40 percent and the posterolateral fusion rate with interbody fusion was 37 percent.
5. The Northwest region of the country had the highest rate of interbody fusions — 41 percent. This was more than 10 percent higher than any other region and more than 23 percent higher than the Southeast region. "The rapid adoption of IF and substantial regional variation in treatment utilization patterns raises questions about drivers of change including the perceptions about associated fusion rates, the importance of sagittal balance and differential reimbursement," concluded study authors.