Does a Referral to a Spine Surgeon Mean Surgery?

One prevailing perception of spine surgeons (in general)—whether neurosurgeons, orthopedic surgeons, or other—is that if you’ve been referred for an appointment with one, it automatically means you’ll be having back surgery.

While certainly, this is not always true (and please keep in mind that you have a right to seek opinions from more than one doctor), it may be useful to you in your research to note that several studies looking at the rate of utilization of spinal fusion surgery, a procedure performed by both orthopedic surgeons and by neurosurgeons, do point in this direction.

For example, Cowan, Dimick, Wainess, Upchurch, Chandler, La Marca found in their 2006 study, “Changes in the utilization of spinal fusion in the United States,” that fusions for the three main regions of the spine increased between 1993 and 2003. Neck fusions, they say, increased by 89%, while fusions in the thoracolumbar (mid to low back area) rose by 31%. And lumbar spinal fusions increased by a whopping 134%.

The researchers also found that cervical and lumbar fusions increased the most for patients who were between the ages of 40 and 59. The number of fusions given to patients 60 years and older also rose.

And finally, Cowan, et. al. found that as an inpatient procedure, spinal fusion was much more common in 2003 than in 1997; In 1997, it was the 41st most common procedure; in 2003, the 19th.

What’s Behind the Rise in Spinal Fusions?

One might conjecture a number of possible reasons for the acceleration. But in their study, “United States trends in lumbar fusion surgery for degenerative conditions,” Deyo, et. al. reviewed records of spinal fusions given between 1998 and 2001. (They used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample and U.S. Census data to do so.)

The authors of this study comment that the increases in fusion procedures, which were “much greater than increases in other major orthopedic procedures,” seem to correspond with the FDA’s approval of new surgical implants.

Deyo, et. al. also comment that during this time period, the most rapid increase in spinal fusion surgery occurred in the over 60 crowd; in other words, seniors and the elderly.

Deyo and his team call for better data around how effective spinal fusion is for patients, noting “these increases were not associated with reports of clarified indications or improved efficacy.”