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Lumbar decompression for spinal stenosis with radicular pain and weakness often is superior to conservative care. In patients with spinal instability caused by degenerative spondylolisthesis or scoliosis, simple fusion at one or two levels also might be necessary. No clear indications exist for complex fusions using instrumentation, bone-graft augmentation, or combined anterior and posterior surgical approaches.
Investigators used Medicare claims data to look at rates and complications of these procedures from 2002 to 2007, during which the overall rate of lumbar stenosis surgery was stable. However, the rate of complex fusions increased 15-fold, from <1% of all procedures in 2002 to almost 15% in 2007. Half of recipients had neither scolios…