title: Trends for Spine Surgery for the Elderly: Implications for Access to Healthcare in North America.
abstract: The proportion of the population over age 65 in the United States continues to increase over time, from 12% in 2000 to a projected 20% by 2030. There is an associated rise in the prevalence of degenerative spinal disorders with this aging population. This will lead to an increase in demand for both nonsurgical and surgical treatment for these disabling conditions, which will stress an already overburdened healthcare system. Utilization of spinal procedures and services has grown considerably. Comparing 1999 to 2009, lumbar epidural steroid injections have increased by nearly 900,000 procedures performed per year, while physical therapy evaluations have increased by nearly 1.4 million visits per year. We review the literature regarding the cost-effectiveness of spinal surgery compared to conservative treatment. Decompressive lumbar spinal surgery has been shown to be cost-effective in several studies, while adult spinal deformity surgery has higher total cost per quality-adjusted life year gained in the short term. With an aging population and unsustainable healthcare costs, we may be faced with a shortfall of beneficial spine care as demand for spinal surgery in our elderly population continues to rise.
  
  
  BACKGROUND
  QALY, quality-adjusted life year.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: O'Lynnger
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Morone
authors.forename: Michael C
authors.initials: MC
authors.lastname: Dewan
authors.forename: Raul A
authors.initials: RA
authors.lastname: Vasquez-Castellanos
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D003362:Cost-Benefit Analysis; D019299:Decompression, Surgical / Q000639:trends*; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D007268:Injections, Epidural; D007738:Kyphosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D009656:North America; D026741:Physical Therapy Modalities; D019057:Quality-Adjusted Life Years; D012600:Scoliosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D013117:Spinal Cord Compression / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D013122:Spinal Diseases / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D013123:Spinal Fusion / Q000639:trends*; D013130:Spinal Stenosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D055009:Spondylosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones