{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:15:09Z","timestamp":1793297709919,"version":"4.5.0"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The increasing cost of lumbar fusion has invited payment reforms, such as mandatory price limits by Medicare in 2026.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the cost, utilization, and procedural case-mix trends for different types of lumbar fusion from 2002 to 2023 in the United States.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional analysis used survey-weighted data from the 2002 to 2023 National Inpatient Sample (NIS) and the 2016 to 2022 Nationwide Ambulatory Surgical Sample (NASS). From this nationally representative sample of inpatient and hospital-owned outpatient discharges, information on US adults aged 20 years and older undergoing lumbar fusion for any indication from January 2002 to December 2023 were included.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Lumbar fusion of any type (1-disc level or multilevel as well as single vertebral column or both anterior-posterior columns) with nonfusion surgery as a comparison.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The main outcomes were the survey-weighted annual total of procedures, the mean age of patients undergoing lumbar fusion, the inflation-adjusted hospital costs, and the annual procedure rates per 100\u202f000 population.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 5\u202f033\u202f772 lumbar fusion admissions between 2002 and 2023 were included. In 2023, the cohort of patients undergoing 274\u202f750 procedures had a mean (SD) age of 63.2 (12.9), with 142\u202f815 (52.0%) female patients. Excluding 54\u202f620 complex fusions, which were mostly multilevel anterior-posterior column fusions, there were 164\u202f105 (50.1%) multilevel fusions, and 109\u202f130 (51.3%) combined anterior-posterior column fusions. The age-adjusted population rate of inpatient fusion procedures increased from 60.1 (95% CI, 58.8-90.3) per 100\u202f000 in 2002 (148\u202f823 admissions) to a peak of 89.9 (95% CI, 89.6-90.3) in 2016 (284\u202f180 admissions), before declining to 80.0 (95% CI, 79.7-80.4) by 2023 (273\u202f235 admissions). Lumbar fusion performed in hospital-owned outpatient facilities was minimal in 2016 (6132 procedures, or 2.1% of total lumbar fusions) and 6.9 per 100\u202f000 (27\u202f331 procedures, or 9.8% of total lumbar fusions) in 2022. Adjusted inpatient hospital costs increased 265.3% from $3.86 (95% CI, $3.81-$3.92) billion in 2002 to $14.1 (95% CI, $13.9-$14.2) billion in 2023, and mean inpatient per-procedure cost increased from $25\u202f849 (95% CI, $25\u202f684-$26\u202f015) in 2002 to $45\u202f458 (95% CI, $45\u202f207-$45\u202f709) in 2023. Lumbar fusion primarily shifted from single column at 1 or 2 disc levels in 2002 (mean cost, $24\u202f515; 95% CI, $24\u202f361-$24\u202f669) to multilevel anterior-posterior column fusion in 2023 (mean cost, $55\u202f034; 95% CI, $54\u202f420-$55\u202f650).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, lumbar fusion trends were marked by greater utilization of procedures overall, and especially involving multilevel and combined anterior-posterior column approaches and by greater use in the outpatient setting. Costs also increased at both the national and per-procedure levels.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.0452","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:30:31Z","timestamp":1772641831000},"page":"e260452","source":"Crossref","is-referenced-by-count":8,"title":["Cost and Utilization Trends of Lumbar Fusion"],"prefix":"10.1001","volume":"9","author":[{"given":"Brook I.","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohail K.","family":"Mirza","sequence":"additional","affiliation":[{"name":"Thayer School of Engineering at Dartmouth College, Hanover, New Hampshire"},{"name":"Inova Department of Orthopaedic Surgery, Fairfax, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian A.","family":"Karamian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunkyu","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep","family":"Suri","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Clinical Learning, Evidence, and Research Center (CLEAR), University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrel S.","family":"Brodke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"issue":"167","key":"zoi260034r1","volume":"89","author":"Centers for Medicare & Medicaid Services","year":"2024","journal-title":"Fed Regist"},{"issue":"2","key":"zoi260034r2","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1007\/s00586-002-0493-8","article-title":"Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study: a report from the Swedish Lumbar Spine Study Group.","volume":"12","author":"Fritzell","year":"2003","journal-title":"Eur Spine J"},{"issue":"21","key":"zoi260034r3","doi-asserted-by":"publisher","first-page":"2351","DOI":"10.1097\/BRS.0b013e3181b8a829","article-title":"Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial.","volume":"34","author":"Abdu","year":"2009","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"zoi260034r4","doi-asserted-by":"publisher","first-page":"1939","DOI":"10.1097\/CORR.0000000000003487","article-title":"Is civilian hospital treatment of lumbar spinal disorders associated with greater odds of fusion procedures?","volume":"483","author":"Lawlor","year":"2025","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"zoi260034r9","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.","volume":"43","author":"Quan","year":"2005","journal-title":"Med Care"},{"issue":"9","key":"zoi260034r10","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1097\/BRS.0000000000000275","article-title":"Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.","volume":"39","author":"Martin","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"zoi260034r11","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/S0030-5898(05)70050-X","article-title":"Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technique.","volume":"29","author":"McCullen","year":"1998","journal-title":"Orthop Clin North Am"},{"issue":"4","key":"zoi260034r12","doi-asserted-by":"publisher","first-page":"189","DOI":"10.2185\/jrm.2020-031","article-title":"Comparison of clinical results of decompression\/fusion surgery for paralysis caused by metastatic spinal tumors of unknown versus known origin.","volume":"15","author":"Miura","year":"2020","journal-title":"J Rural Med"},{"issue":"4","key":"zoi260034r13","doi-asserted-by":"publisher","first-page":"665","DOI":"10.3171\/2020.8.SPINE201166","article-title":"Survival, fusion, and hardware failure after surgery for spinal metastatic disease.","volume":"34","author":"Yee","year":"2021","journal-title":"J Neurosurg Spine"},{"issue":"3","key":"zoi260034r14","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/01.BRS.0000109410.46538.74","article-title":"Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion.","volume":"29","author":"Dimar","year":"2004","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"zoi260034r15","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1097\/00002517-199407020-00012","article-title":"Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion.","volume":"7","author":"Fang","year":"1994","journal-title":"J Spinal Disord"},{"issue":"6","key":"zoi260034r16","doi-asserted-by":"publisher","first-page":"843","DOI":"10.2106\/00004623-198769060-00008","article-title":"Adult idiopathic scoliosis treated by anterior and posterior spinal fusion.","volume":"69","author":"Byrd","year":"1987","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"zoi260034r17","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/S0001-2092(07)66776-3","article-title":"Adult lumbar scoliosis. Treatment with combined anterior-posterior spinal fusion.","volume":"54","author":"Gaehle","year":"1991","journal-title":"AORN J"},{"issue":"7502","key":"zoi260034r18","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1136\/bmj.38441.620417.8F","article-title":"Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial.","volume":"330","author":"Fairbank","year":"2005","journal-title":"BMJ"},{"issue":"17","key":"zoi260034r19","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1097\/01.BRS.0000083234.62751.7A","article-title":"Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.","volume":"28","author":"Brox","year":"2003","journal-title":"Spine (Phila Pa 1976)"},{"issue":"11","key":"zoi260034r20","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1016\/j.spinee.2013.06.101","article-title":"Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.","volume":"13","author":"Mannion","year":"2013","journal-title":"Spine J"},{"issue":"5","key":"zoi260034r21","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.spinee.2015.12.001","article-title":"Consensus at last! long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain.","volume":"16","author":"Mannion","year":"2016","journal-title":"Spine J"},{"issue":"7","key":"zoi260034r22","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1056\/NEJMsb031771","article-title":"Spinal-fusion surgery\u2014the case for restraint.","volume":"350","author":"Deyo","year":"2004","journal-title":"N Engl J Med"},{"issue":"13","key":"zoi260034r23","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.","volume":"303","author":"Deyo","year":"2010","journal-title":"JAMA"},{"issue":"1","key":"zoi260034r24","doi-asserted-by":"publisher","first-page":"42","DOI":"10.3171\/2014.4.SPINE14270","article-title":"Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine\u2014part 7: lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis.","volume":"21","author":"Eck","year":"2014","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"zoi260034r26","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1097\/BRS.0000000000002822","article-title":"Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.","volume":"44","author":"Martin","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"zoi260034r27","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1097\/BRS.0b013e31820cccfb","article-title":"Spinal fusion in the United States: analysis of trends from 1998 to 2008.","volume":"37","author":"Rajaee","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"zoi260034r28","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1097\/MLR.0000000000001496","article-title":"The impact of halting elective admissions in anticipation of a demand surge due to the coronavirus pandemic (COVID-19).","volume":"59","author":"Martin","year":"2021","journal-title":"Med Care"},{"issue":"6","key":"zoi260034r29","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.2106\/JBJS.H.00913","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts.","volume":"91","author":"Weinstein","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"22","key":"zoi260034r30","doi-asserted-by":"publisher","first-page":"2257","DOI":"10.1056\/NEJMoa070302","article-title":"Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.","volume":"356","author":"Weinstein","year":"2007","journal-title":"N Engl J Med"},{"issue":"23","key":"zoi260034r31","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1097\/BRS.0000000000002682","article-title":"Long-term results of surgery compared with nonoperative treatment for lumbar degenerative spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT).","volume":"43","author":"Abdu","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"issue":"10","key":"zoi260034r32","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1097\/BRS.0b013e31827db30f","article-title":"Single- versus multilevel fusion for single-level degenerative spondylolisthesis and multilevel lumbar stenosis: four-year results of the Spine Patient Outcomes Research Trial.","volume":"38","author":"Smorgick","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"Suppl 3","key":"zoi260034r33","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/s00586-009-0908-x","article-title":"The case for restraint in spinal surgery: does quality management have a role to play?","volume":"18","author":"Deyo","year":"2009","journal-title":"Eur Spine J"},{"issue":"6","key":"zoi260034r34","doi-asserted-by":"publisher","first-page":"686","DOI":"10.3171\/spi.2005.2.6.0686","article-title":"Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine\u2014part 10: fusion following decompression in patients with stenosis without spondylolisthesis.","volume":"2","author":"Resnick","year":"2005","journal-title":"J Neurosurg Spine"},{"issue":"6","key":"zoi260034r35","doi-asserted-by":"publisher","first-page":"673","DOI":"10.3171\/spi.2005.2.6.0673","article-title":"Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine\u2014part 8: lumbar fusion for disc herniation and radiculopathy.","volume":"2","author":"Resnick","year":"2005","journal-title":"J Neurosurg Spine"},{"issue":"6","key":"zoi260034r36","doi-asserted-by":"publisher","first-page":"670","DOI":"10.3171\/spi.2005.2.6.0670","article-title":"Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine\u2014part 7: intractable low-back pain without stenosis or spondylolisthesis.","volume":"2","author":"Resnick","year":"2005","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"zoi260034r37","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3171\/2020.1.SPINE191288","article-title":"Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts.","volume":"33","author":"Yanik","year":"2020","journal-title":"J Neurosurg Spine"},{"issue":"3_suppl","key":"zoi260034r38","doi-asserted-by":"publisher","first-page":"7S","DOI":"10.1177\/21925682231203656","article-title":"Determining the magnitude of surgery in patients with adult scoliosis: a systematic review of the role of limited fusions.","volume":"15","author":"Sardi","year":"2025","journal-title":"Global Spine J"},{"issue":"3","key":"zoi260034r39","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1177\/21925682221127955","article-title":"Decompression alone in the setting of adult degenerative lumbar scoliosis and stenosis: a systematic review and meta-analysis.","volume":"13","author":"Echt","year":"2023","journal-title":"Global Spine J"},{"issue":"1","key":"zoi260034r40","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1007\/s43465-024-01229-w","article-title":"Effect of approach based lumbar interbody fusion on sagittal spinopelvic parameters and functional outcomes: comparison between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF).","volume":"59","author":"Jain","year":"2024","journal-title":"Indian J Orthop"},{"key":"zoi260034r41","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.1016\/j.wneu.2023.03.005","article-title":"Do on-table radiographs predict postoperative sagittal alignment after posterior lumbar fusion?","volume":"174","author":"Siegel","year":"2023","journal-title":"World Neurosurg"},{"key":"zoi260034r42","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1016\/j.wneu.2017.06.005","article-title":"Which approach is advantageous to preventing development of adjacent segment disease? comparative analysis of 3 different lumbar interbody fusion techniques (ALIF, LLIF, and PLIF) in L4-5 spondylolisthesis.","volume":"105","author":"Lee","year":"2017","journal-title":"World Neurosurg"},{"issue":"1","key":"zoi260034r43","doi-asserted-by":"publisher","first-page":"89","DOI":"10.21037\/atm-20-1971","article-title":"Narrative review of intraoperative image guidance for transforaminal lumbar interbody fusion.","volume":"9","author":"Weiner","year":"2021","journal-title":"Ann Transl Med"},{"issue":"6","key":"zoi260034r44","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.spinee.2023.02.016","article-title":"Intraoperative CT for lumbar fusion is not associated with improved short- or long-term complication profiles.","volume":"23","author":"Crawford","year":"2023","journal-title":"Spine J"},{"issue":"6","key":"zoi260034r45","doi-asserted-by":"publisher","first-page":"1966","DOI":"10.1007\/s00586-023-07663-y","article-title":"Robotic assistance in lumbar fusion surgery: trends and patterns from 2016-2019.","volume":"32","author":"Pando","year":"2023","journal-title":"Eur Spine J"},{"issue":"21","key":"zoi260034r46","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1097\/BRS.0000000000005032","article-title":"Robotic-assisted versus navigation-assisted posterior lumbar fusion: a national database study.","volume":"49","author":"Gouzoulis","year":"2024","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"zoi260034r47","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.esas.2010.03.004","article-title":"Value and cost in less invasive spinal fusion surgery: lessons from a community hospital.","volume":"4","author":"Deluzio","year":"2010","journal-title":"SAS J"},{"key":"zoi260034r48","journal-title":"Clin Orthop Relat Res"},{"key":"zoi260034r5","unstructured":"Agency for Healthcare Research and Quality; Healthcare Cost and Utilization Project. National Inpatient Sample (NIS). Accessed July 21, 2025. https:\/\/hcup-us.ahrq.gov\/db\/nation\/nis\/nisdbdocumentation.jsp"},{"key":"zoi260034r6","unstructured":"Ruggles? SFS, Sobek? M, Backman? D, . IPUMS USA: version 15.0. Accessed January 21, 2026. https:\/\/www.ipums.org\/projects\/ipums-usa\/d010.V15.0"},{"key":"zoi260034r7","unstructured":"American Hospital Association. AHA Annual Survey Database. Accessed January 24, 2025. https:\/\/www.ahadata.com\/aha-annual-survey-database"},{"key":"zoi260034r8","unstructured":"Agency for Healthcare Research and Quality; Healthcare Cost and Utilization Project Nationwide Ambulatory Surgery Sample (NASS). Accessed July 21, 2025. https:\/\/hcup-us.ahrq.gov\/db\/nation\/nass\/nassdbdocumentation.jsp"},{"key":"zoi260034r25","unstructured":"Federal Reserve Bank of St Louis. Implicit price deflator. Accessed July 21, 2025. https:\/\/fred.stlouisfed.org\/series\/GDPDEF"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2845875\/martin_2026_oi_260034_1772472390.56633.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T16:30:32Z","timestamp":1772641832000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2845875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":48,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.0452","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}