Surgery rates for lumbar spinal stenosis in Denmark between 2002 and 2018: a registry-based study of 43,454 patients

Abstract

Background and purpose: Over the last decades, many countries have shown increased surgery rates for lumbar spinal stenosis (LSS), but little information is available from Denmark. We describe the development in diagnosis and surgery of LSS in Denmark between 2002 and 2018.Patients and methods: We collected diagnostic ICD10-codes and surgical procedure codes from private and public hospitals in Denmark from the Danish National Patient Register. Patients diagnosed with LSS and those with surgical procedure codes for decompression surgery with or without fusion were identified. Annual surgery rates were stratified by age, sex, and type of surgery.Results: During these 17 years, 132,138 patients diagnosed with LSS and 43,454 surgical procedures for LSS were identified. The number of surgical procedures increased by 144%, from 23 to 56 per 100,000 inhabitants. The proportion of patients diagnosed with LSS who received surgery was about 33%, which was almost stable over time. Decompression without fusion increased by 128% from 18 to 40 per 100,000 inhabitants and decompression with fusion increased by 199%, from 5 to 15 per 100,000.Interpretation: Both the prevalence of LSS diagnoses and LSS surgery rates more than doubled in Denmark between 2002 and 2018. However, the proportion of patients diagnosed with LSS who received surgery remained stable. Decompression surgery with fusion increased at a higher rate than decompression without fusion, although recent evidence suggests no advantage of decompression plus fusion over decompression alone.

Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019

“…The continued increase in the use of decompression with fusion procedures in the US was unexpected and meaningful in the context of observed patterns among health care systems in other countries, such as those of Finland and Denmark, in which rates of decompression with fusion have either plateaued or declined substantially since 2016 . One of many possible explanations for this observation is that the findings from relevant RCTs, 2 of which were conducted in Europe, are not applicable to clinical practice, especially in a US patient population.…”

Incidence of subsequent surgical decompression following minimally invasive approaches to treat lumbar spinal stenosis: A retrospective review

“…Symptomatic lumbar spinal canal stenosis is a debilitating condition and increasingly affects the aging population, with a mean prevalence upwards of 39% 1 . Surgical decompression, which is performed in approximately 30% of cases, 2 is considered the gold‐standard treatment for patients with symptomatic lumbar spinal stenosis who are refractory to conservative management 3 . However, in certain groups of patients, spine surgery may be associated with considerable morbidity and prolonged recovery 4–8 .…”

Trends of Surgical Service Utilization for Lumbar Spinal Stenosis in South Korea: A 10-Year (2010–2019) Cross-Sectional Analysis of the Health Insurance Review and Assessment Service—National Patient Sample Data

“…A study conducted in Denmark from 2002 to 2018 examined surgery rates for LSS, revealing an overall annual surgery rate of 33% among diagnosed patients. During the study period, the rate of decompression without fusion increased by 128%, while the rate of decompression with fusion showed a larger increase of 199% [ 12 ]. Similarly, in the U.S., a study reported a 113% increase in lumbar fusion surgeries in 2001 compared to 1996 [ 13 ].…”