Large Rises in Thoracolumbar Fusions by 2040: A Cause for Concern with an Increasingly Elderly Surgical Population

With a growing aging population in the United States, the number of operative lumbar spine pathologies continues to grow. Therefore, our objective was to estimate the future demand for lumbar spine surgery volumes for the United States to the year 2040.

The National/Nationwide Inpatient Sample was queried for years 2003-2015 for anterior interbody and posterior lumbar fusions (ALIF, PLF) to create national estimates of procedural volumes for those years. The average age and comorbidity burden was characterized, and Poisson modeling controlling for age and sex allowed for surgical volume prediction to 2040 in 10-year increments. Age was grouped into categories (<25, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and >85 years), and estimates of surgical volumes for each age subgroup were created.

ALIF volume is expected to increase from 46,903 to 55,528, and PLF volume is expected to increase from 248,416 to 297,994 from 2020 to 2040. For ALIF, the largest increases are expected in the 45-54 years (10,316 to 12,216) and 75-84 years (2,898 to 5,340) age groups. Similarly the largest increases in PLF will be seen in the 65-74 years (71,087 to 77,786) and 75-84 years (28,253 to 52,062) age groups.

The large increases in expected volumes of ALIF and PLF could necessitate training of more spinal surgeons and an examination of projected costs. Further analyses are needed to characterize the needs of this increasingly large population of surgical patients.