The state of spinal fusion in 4 studies


Spinal fusion has been widely performed in spine care, but newer technologies and techniques have drawn more interest in recent years. Some spine surgeons even say that spinal fusion is becoming overutilized.

Here are four recent studies that illustrate the state of spinal fusion now and where it's headed.

1. Anterior cervical discectomy and fusion costs significantly less when performed in ASCs than the hospital setting for Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine. Researchers examined data from 6,504 patients from the Quality Outcomes Database who underwent one and two level fusions. There were 520 patients who underwent the surgery in ASCs compared with 5,984 patients who had their procedures done in a hospital. Total costs for spinal fusion in the ASC at one year were $5,879, compared with $12,873 for procedures in the hospital.

2. Although the cost of anterior cervical discectomy and fusion and cervical disc replacement costs are similar, long-term costs are different, according to a study in the April issue of Spine. Researchers used a commercial insurance claims database to analyze data from patients who had one- or two-level ACDF and cervical disc replacements between Jan. 1, 2017, and Dec. 31, 2017. A total of 2,304 patients were included — 1,723 ACDF patients and 581 disc replacement patients. Prices for the surgeries were similar with ACDF mean costs of $26,819, and disc replacement mean costs of $25,954. However postoperative care — which includes physical therapy, pain medication, injections, psychological treatment and additional spine surgeries — cost less for disc replacements after 30 days, 90 days and two years.

3. Bundled payments from private insurers were a viable option for lumbar spinal fusion patients, according to a study published in the January 2024 issue of Spine. The study looked at lumbar spinal fusion patients from October 2018 to December 2018 who used CMS' Bundled Payments for Care Improvement Advance model, and compared that data with private bundle data from 2018 to 2020 to analyze the transition away from BPCI-A. Researchers concluded that bundled payments can be successful in lumbar spinal fusions and that "constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses."

4. Anterior cervical discectomy and fusion plateaued while cervical disc replacement has increased significantly from 2011 and 2021, according to a study published Feb. 24 in The Spine Journal. Researchers used the PearlDiver database to analyze patient demographics, complications and revisions for ACDF and cervical disc replacements between 2011 to 2021. More than 404,000 ACDF and more than 29,000 cervical disc replacement patients were included. 

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