Study from Germany Projects Increasing Demand – and Cost – for Posterior Spinal Fusion

The demand for posterior spinal fusion procedures is expected to increase by more than 80% by 2060, according to a study from Germany published online ahead of print by Clinical Orthopaedics and Related Research.

This demand will be even greater among older patients, who often need more costly care, placing an enormous strain on healthcare systems, the study authors said.

Spinal fusion is one of the costliest surgical procedures performed in developed nations, and in recent decades its use has become more frequent. Populations of industrialized countries are aging, and the higher proportions of older individuals are expected to lead to even higher demand for spinal fusion, with resultant increased costs.

To assess how the use of posterior spinal fusions in Germany will change as its population ages, Vincent J. Heck, MD, of the University of Cologne, Cologne, Germany, and colleagues examined comprehensive nationwide data provided by the German Federal Statistical Office. They estimated posterior spinal fusion rates as a function of calendar year, age, and gender.

Projecting Procedure Trends

Dr. Heck’s group predicts the use of posterior spinal fusion will increase to 102 procedures per 100,000 residents by 2060, an increase of about 83% compared with the years 2005 to 2019. The number of women undergoing the surgery will be 1.3-fold higher by 2060.

The highest estimated increase will be among patients 75 years and older, with 38,974 posterior spinal fusions projected to be performed in 2060 compared with 14,657 in 2019.

This trend will apply both to older women and men, with a 246% increase in the total number for women 75 years and older and a 296% increase for men 75 years and older. At the same time, the number of posterior spinal fusions in all age groups younger than 55 are projected to stay constant or even decline up to 2060.

The implications for healthcare systems include:

  • A larger number of patients undergoing posterior spinal fusion surgery will have age-related comorbid conditions such as osteoporosis, cardiovascular disease, and age-related loss of muscle mass
  • The population of patients having the surgery will be at increased risk of postoperative complications, longer hospital stays, and being discharged to skilled nursing facilities or other places besides their homes, ultimately resulting in higher healthcare costs

Planning Ahead

Dr. Heck and colleagues said their findings “suggest that increasing use of posterior spinal fusion, particularly in patients 75 years and older, will challenge healthcare systems worldwide if current trends persist.”

Although these data are from a single European county, the study authors explained that many other developed countries have had comparable procedure-specific trends in the past and will face similar demographic changes in the future. Therefore, the projections about posterior spinal fusion are likely to apply to healthcare systems in many other nations.

“Given the known risk factors associated with the surgical treatment of older patients, we think anticipatory human and financial resource planning, frailty as a focus of research, and the development of interinstitutional protocols that focus on effective perioperative medical care for these patients will be important elements of managing these trends in the future,” they concluded.

Read the full article here.


Heck VJ, Klug K, Prass T, et al. Projections from surgical use models in Germany suggest a rising number of spinal fusions in patients 75 years and older will challenge healthcare systems worldwide. Clin Orthop Relat Res. 2023 Feb 10. doi: 10.1097/CORR.0000000000002576. Online ahead of print.

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