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Major Shift in the Pattern of Neck Surgery—in the Absence of Rigorous Scientific Evidence

plained shift in the pattern of neck surgery in the United States. While overall cervical surgery rates for degenerative disc disease held steady from 1990 to 1999, the proportion of surgeries that involved a cervical fusion rose precipitously. The change in clinical practice did not appear to be prompted by a tsunami of rigorous scientific research demonstrating that the routine use fusion provides a clear benefit for patients. “The rate of discectomy with fusion showed a 40% increase for males and a 62% increase for females between 1990 and 1999,” according to neurosurgeon Peter D. Angevine, MD, et al. There was a corresponding decrease in the rates of discectomy without fusion. (See Angevine et al., 2003.) By 1999, 90% of all cervical discectomies for degenerative disc disease in the United States included a fusion, according to the nationwide study. (See Angevine et al., 2003.) The new study also documented substantial geographic variation in the pattern of cervical surgery across the United States. A patient in the southern United States was nearly twice as likely to undergo cervical surgery for degenerative disc disease than an individual in the north or the west. This suggests a lack of consensus over indications for surgery, even among experts in the same surgical disciplines.