The rates of lower back surgery and of surgery for spinal stenosis increased dramatically during the 1980s (Ciol, Deyo, Howell et al., 1996). Data from the National Hospital Discharge Survey showed an age-adjusted 40 percent increase in lumbar spine surgery between 1979 and 1992 from 113 per 100,000 to 132 per 100,000. The increase for older patients was even greater, from 51 per 100,000 to 188 per 100,000, a 3.7-fold increase. This latter increase was attributed mainly to an increase in surgery for spinal stenosis, from 7.8 per 100,000 to 61.4 per 100,000, an almost eight-fold increase. Most of these increases occurred in the early 1980s and appeared to be leveling off by the early 1990s (Davis, 1994); however, we found no published systematic data on back surgery rates during the late 1990s.
According to Medicare records
(patients 65 and over), the rate of spinal stenosis surgery in 1989 varied among
states by more than four-fold, from 30 per 100,000 in Rhode Island to 132 per
100,000 in Utah (Ciol, Deyo, Howell et al., 1996). The rates were generally highest in
Pacific and Mountain states and lowest in
Reoperation is an important part of lower back surgeries. A population-based cohort study of patients receiving lower back surgery in 1988 in Washington State reported that within five years there was an 18 percent reoperation rate for patients receiving fusion surgery and a 15 percent reoperation rate for those receiving nonfusion lower back surgery (Malter, McNeney, Loeser et al., 1998).
Ciol and colleagues used the United States Health Care Financing Administration data for the cohort of Medicare beneficiaries who received lumbar spine surgery in 1985 to estimate the rate of reoperation for this type of surgery (Ciol, Deyo, Kreuter et al., 1994). All hospitalizations up to four years after the surgery were examined for repeat surgery. After excluding for malignancy, infection, fracture, trauma, and Medicare eligibility based on end-stage renal disease, 27,111 patients were identified as having lumbar spine surgery related to spinal stenosis (39.3 percent), herniated disk (41.4 percent), degenerative disk disease (11.6 percent), or possible instability (3.3 percent). The average patient age was 71.8 years (range 59 to 97), 57.1 percent were women, and 92.7 percent were white. After four years, the rate of reoperation for lumbar spinal stenosis was approximately 10 percent and the reoperation rate for herniated disks was approximately 12 percent.