Study: Insurance restrictions on lumbar fusions push procedure volumes down

An insurance policy limit on lumbar fusion procedures helped slash costs and medically unnecessary surgeries in North Carolina, and the approach could work nationally, according to new research published in the journal Spine. “The commercial insurance policy change had its intended effect of reducing fusion operations for indications with less evidence of effectiveness, without changing rates for other indications or resulting in an overall reduction in spine surgery,” the authors wrote. “Broader adoption of the policy could significantly reduce the national rates of fusion operations and associated costs.” Researchers analyzed North Carolina’s inpatient database from 2005 through 2012, plus the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from nonfederal hospitals. Specifically, the authors looked at adults undergoing elective lumbar fusion or re-fusion operations. They found that lumbar fusion for herniated discs saw a “substantial decline” after the commercial policy change limiting lumbar fusion for some indications hit Jan. 1, 2011. Before that point, overall rates of elective lumbar fusion operations in North Carolina had jumped 16.7% from 103.2 per 100,000 residents in 2005 to 120.4 in 2009. By 2012, the number dropped -15.4% to 101.9, -1.3% below the 2005 rate. The numbers were even more dramatic for younger patients. Rates of elective lumber fusion operations in patients under a...
Source: Mass Device - Category: Medical Equipment Authors: Tags: Spinal Surgical Wall Street Beat Source Type: news

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CONCLUSION: For patients with spondylolisthesis-associated low back and leg pain without spinal instability, TFELD is a safe and effective surgical treatment option. PMID: 32227330 [PubMed - as supplied by publisher]
Source: Surgical Technology International - Category: Surgery Tags: Surg Technol Int Source Type: research
Authors: Smith EJ, Inkrott BP, Kim CY, Du JY, Ahn UM, Ahn NU Abstract The prevalence of obesity has been rising, creating a major public health concern. While several studies have shown obesity to increase the risk of surgical complications, few have analyzed its effects on reoperation, specifically after singlelevel lumbar discectomy. Data was obtained using the commercially available Explorys software that houses deidentified data for several major healthcare systems. A database search was used to find all patients who had undergone a lumbar discectomy. Scoliosis, spondylolisthesis, smoking history and depression...
Source: Journal of surgical orthopaedic advances - Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research
No abstract available
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Controversies in Spine Surgery Source Type: research
CONCLUSIONS: A high index of suspicion is needed to diagnose sacral insufficiency fracture after LS arthrodesis. A trial of conservative management is reasonable for select patients; potential surgical indications include refractory pain, neurological deficit, fracture nonunion with anterolisthesis or kyphotic angulation, L5-S1 pseudarthrosis, and spinopelvic malalignment. Lumbopelvic fixation with iliac screws may be effective salvage treatment to allow fracture healing and symptom improvement. High-risk patients may benefit from prophylactic lumbopelvic fixation at the time of index LS arthrodesis. PMID: 32217798 [P...
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research
To compare standalone oblique lateral interbody fusion (OLIF) vs. OLIF combined with posterior bilateral percutaneous pedicle screw fixation (OLIF combined) for the treatment of lumbar spondylolisthesis.
Source: BMC Musculoskeletal Disorders - Category: Orthopaedics Authors: Tags: Research article Source Type: research
CONCLUSIONS: Mini-open anterolateral interbody fusion at the L5 S1 level is safe and results in fusion at the same rate as anterior interbody fusion. Most acute complications are minor and resolve spontaneously. PMID: 32197973 [PubMed - as supplied by publisher]
Source: Neurochirurgie - Category: Neurosurgery Tags: Neurochirurgie Source Type: research
CONCLUSIONS: When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved. LEVEL OF EVIDENCE: Level II, prognostic study. PMID: 32197034 [PubMed - as supplied by publisher]
Source: Clinical Orthopaedics and Related Research - Category: Orthopaedics Authors: Tags: Clin Orthop Relat Res Source Type: research
This study sought to determine the impact of time to surgery on clinical outcomes in patients with spondylolisthesis in the workers' compensation (WC) population. There is conflicting evidence regarding the effect of time to surgery on patients with spondylolisthesis. Patients receiving WC are known to have worse outcomes following spine surgery compared with the general population. A total of 791 patients from the Ohio Bureau of Workers' Compensation were identified who underwent lumbar fusion for spondylolisthesis between 1993 and 2013. The patients were divided into those who had surgery within 2 years of injury date an...
Source: Orthopedics - Category: Orthopaedics Authors: Tags: Orthopedics Source Type: research
Publication date: Available online 17 March 2020Source: Interdisciplinary NeurosurgeryAuthor(s): Hyeun Sung Kim, Pang Hung Wu, Il-Tae Jang
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
e A Abstract OBJECTIVE: Minimally invasive posterior segmental instrumentation and intra-articular fusion with the Facet Wedge device. INDICATIONS: All fusion indications in degenerative disc disease without significant translational instability, postnucleotomy syndrome, spondylarthrosis, discitis. CONTRAINDICATIONS: Translatory instabilities, status after decompression with partial facet joint resection, spondylolysis in the affected segment. SURGICAL TECHNIQUE: Through a 3 cm skin incision, blunt transmuscular approach to the corresponding facet joint L1/2 to L5/S1. Opening of the joint cap...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Tags: Oper Orthop Traumatol Source Type: research
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