by Michael Woodhead  

A disproportionate increase in spinal fusion surgery in private practice in recent years may reflect overservicing by surgeons, Australian researchers say.  

Figures from NSW show that rates of lumbar spinal fusion have increased three fold in the private sector since 1997 but only by 2% in public sector.  

The large increase is puzzling, especially since the evidence for the benefits of spinal fusion is weak, say the authors of a study in the ANZ Journal of Surgery (79: 783-8).  

Their review shows that most of the increase was seen for spine fusions with instrumentation such as cages and screws, which carry greater financial incentives than other procedures.  

The increase seen in spinal fusion performed in the private sector could not be explained by the ageing of the population or by changes in private health coverage, say the researchers. 

The increase might be related to increased use of MRI scans for back pain, but they note that there was no increase in demand for the procedure in the public sector.  

Lead study author Professor Ian Harris, director of orthopaedics at the Liverpool Hospital in Sydney, says the indications for surgery may change over time, but this does not explain the disproportionate increase  in spinal fusion compared to other procedures such as hip and knee arthroplasty, or the increase being seen mostly in privately insured patients.  

“Reimbursement for performing spinal procedures ... is more favourable than reimbursement for most other procedures performed by spine surgeons, and the reimbursement is higher for privately insured patients,” he notes.