An Assessment of Surgery for Spinal Stenosis: time
trends, geographic variations, complications, and
reoperations.

J Am Geriatr Soc 1996 Mar; 44:285-90.
Ciol MA; et al.
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Spinal stenosis is more common in older adults and causes
spinal-nerve-root compression and subsequent motor and sensory
symptoms. Stenosis prevalence has increased with improvements in
diagnostic imaging and the aging of the U.S. population.

To analyze the use of surgery for spinal stenosis, researchers at the
University of Washington studied Medicare claims data on all
beneficiaries over age 65 who underwent surgery in 1985 (10,260
patients) or 1989 (18,655 patients) and were followed through 1991.
They evaluated surgery rates, postoperative morbidity and mortality,
and reoperation rates.

Whereas the Medicare population increased by only 8 percent between
1985 and 1989, the rate of surgery for spinal stenosis increased by
81 percent! Furthermore, between 1979 and 1992, back surgery rates
for patients under age 65 increased by only 40 percent, while
quadrupling for those over 65 -- primarily because of an eightfold
increase in spinal stenosis surgery.

Regression analysis showed that patients older than 80 were twice as
likely to have surgical complications than those age 65 to 69, and
that complications increased with increasing comorbidity.

Patients undergoing fusion were 1.7 times more likely to
have a complication than those who did not. Reoperation
rates were slightly higher in the 1989 cohort.

Editorial comment: Unfortunately, no randomized clinical trial has
compared the efficacy of surgical versus conservative treatment for
spinal stenosis. These data suggest that such a trial is needed to
justify the escalating rates of surgery for this condition. 

Lon Morgan, DC 
lmorgan@primenet.com