Geographic Comparison of Lumbar Spine Surgery in Canada
• Recent trials have failed to demonstrate a superiority of fusion over decompression for degenerative conditions of the lumbar spine.
• Little is known about the current landscape of lumbar spine surgery in Canada.
Methods
Study Design
Retrospective analysis of data from the hospital Discharge Abstract Database from 2007–2018 for 9 of 10 Canadian provinces.
Only inpatient surgery was captured
Demographics
A sample population of 86 805 cases were identified (Female n= 44,470). Median age of 66y (SD 13y).
Patient Selection
Cases with a primary or secondary diagnosis of spinal stenosis or spondylolisthesis of the lumbar spine undergoing operative treatment were included.
Pathology
Patients with stenosis represented 66,740 cases, and patients with spondylolisthesis were 42,335 cases.
Our study
We explored geographic patterns in surgery for stenosis and spondylolisthesis in Canada over a 10-year period.
Findings
We found significant variation between regions in the proportions of decompressions versus fusions for lumbar stenosis. Given our large sample size and similar population prevalences, this finding is unlikely to be explained by patient factors alone.
For spondylolisthesis, treatment proportions were much more uniform across Canada.
Future Directions
Our data suggests that regional variations in surgeon training and preference play a larger role than patient factors, and is an area for future exploration.
There is potential for significant cost savings given the high 2-year costs of fusion surgeries.
Interested in the numbers? See our work
Kit Moran, Jo Anne Douglas, Lynn Lethbridge, Andrew Glennie