Are unnecessary spinal surgeries on the rise? Here's why the answer might be complicated


CMS is currently projecting an over 100 percent increase in the number of hip and knee replacements performed by 2040. 

An estimated 34 percent of knee replacement surgeries are currently deemed unnecessary, leading surgeons and researchers to question such a rapid increase in procedures performed.

Several spine and orthopedic surgeons have shared concerns about a rise in procedures, warning surgeons to be vigilant about the temptation to "overserve." 

However, there could be other causes for a rise in spinal and orthopedic procedures, Dom Coric, MD, the executive medical director at Atrium Health's Spine Center of Excellence in Winston-Salem, N.C., and Anthony Asher, MD, president of Atrium Health's Neuroscience Institute, told Becker's in a statement co-authored on Aug. 16. 

Question: Are you concerned about a potential increase in unnecessary procedures in the field?

Dr. Coric and Dr. Asher: The answer to this question is not a simple one, particularly as it presupposes that there has been a steep increase in unnecessary spine surgeries.

Of course, all surgeons should be concerned with any perceived or actual increase in unnecessary surgeries. However, we respectfully believe this topic mandates a more complete treatment than what can be offered in a format that places a premium on brevity. For present purposes, what we would state is:

The concept of over-utilization of surgery is controversial and complicated. Certainly, not every surgical procedure may be the most effective treatment option. While we believe it is not easy to determine whether our current healthcare system is routinely predisposed towards over-utilization of elective procedures, it can perhaps be stated with more certainty that multiple factors are contributing to a justifiable, or at least understandable, increase in the number of spinal surgical procedures, including, but not limited to: the aging of the baby boomer generation, the increased utilization of surgical spinal codes by non-spinal surgeons, COVID-19 global pandemic under-utilization, reserving surgical consideration for essential, life or limb-threatening, procedures and advances in surgical technique and instrumentation, including minimally invasive techniques that decrease surgical morbidity.

We firmly believe the best path forward is to continue practicing evidence-based medicine with multi-disciplinary treatment paradigms emphasizing pre-operative optimization and quality outcome assessment. It is imperative that spine surgery is performed by qualified neurosurgeons and orthopedic spine surgeons. Furthermore, we need to expand our existing national efforts to assess the clinical and economic value of the care we provide through promoting the routine use of data programs by all North American spine surgeons (such as the Spine CORE study group and the American Spine Registry) designed to examine the relationship between specific treatment methods and clinical outcomes.

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