Neurosurgery’s Editor’s Choice: Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis

Surgical fusion has become one of the most commonly performed procedures for degenerative disease of the lumbar spine.1-3 Over the past decade, the incidence of lumbar fusion for degenerative indications has more than doubled from 7.5 per 100 000 in 2000 to 17.8 per 100 000 in 2009.3,4 Rising rates of fusion have been accompanied by cost per case increases from $24 676 to $81 960 over the same interval.4 As a consequence of both escalating rates and costs, the total annual direct expense of fusion in the United States has risen nearly 8-fold to $33.9 billion.4

The increasingly frequent use of lumbar fusion is complicated by widely varying surgical indications with regional rates differing by up to 20-fold, the greatest measured practice variation of any surgical procedure.5,6 Uncertainty resulting from limited scientific evidence contributes to the observed variation in clinical decision making.5-7 While the overuse of lumbar fusion may result in undue complications and the misallocation of resources, decompression-alone or nonoperative care for degenerative indications may risk progressive spinal instability, intractable pain, and neurological impairment.2,8 In the absence of reliable estimates of the relative risks and benefits of lumbar fusion for degenerative indications, considerable variation in the use of fusion is expected to continue.5

From Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis by Daniel Yavin, MD, Steven Casha, MD, PhD, Samuel Wiebe, MD, MSc, Thomas E Feasby, MD, Callie Clark, MSc, Albert Isaacs, MD, Jayna Holroyd-Leduc, MD, R. John Hurlbert, MD, PhD, Hude Quan, MD, PhD, Andrew Nataraj, M, Garnette R. Sutherland, MD, Nathalie Jette, MD, MSc