GlobalData has updated its outlook on spinal fusions, which have undergone extensive scrutiny from the medical community.
Here are five observations on the spinal fusion:
1. The number of spinal fusions has increased 77 percent from 2002 to 2011, according to the Agency for Healthcare Research and Quality. The AHRQ reported 460,000 spinal fusions performed in 2011. There are several factors associated with this growth, including:
• Increased aging population
• An aging population that wants to remain active longer
• More fellowship-trained spine surgeons practicing in areas that didn't previously have access to spine surgeons
• Advanced techniques allowing surgeons to treat patients who previously weren't good candidates for surgery
However, despite these factors, spinal fusion growth has increased at a higher rate than other procedures such as hip and knee replacement surgery.
2. There is immense pressure to perform fewer spinal fusions than in the past, and the number of procedures will be hindered by reimbursement changes, said the GlobalData analyst. GlobalData's Joseph Gregory reports health insurers, hospital management, spine surgeons and policymakers have all expressed concern about the increasing procedure volumes, some of which may not be associated with medically necessary indications.
3. The indications for performing spinal fusion have expanded. One of the GlobalData analysts in the report said, "One of the primary reasons for this rapid growth is expansion in the indications which spinal fusion surgery is performed. The original intent of spinal fusion was to treat severe scoliosis and spinal tuberculosis, but its indication profile has since increased significantly. Now there are 14 conditions for which the procedure is medically indicated, including degenerative disc disease and stenosis."
The North American Spine Society recently published new coverage policy recommendations for 13 spine procedures, including lumbar fusion and the use of recombinant human bone morphogenetic protein. Among the anticipated recommendations for the future are cervical fusion, minimally invasive lumbar fusion and sacroiliac joint fusion.
4. Spinal fusions remain an expensive procedure and as a result payers are demanding more documentation before approving these procedures. Their reimbursement policies are changing and surgeons across the country are reporting more denials. "Now the payers require extensive documentation to validate the medical necessity of the procedure, including well-documented attempts at conservative care and radiographic imaging to record the source of pain," said the analyst. As a result of these factors, GlobalData has reduced its predicted compound annual growth rate from 10 percent to 5 percent through 2020.
5. There are several non-fusion solutions entering the spine surgery and treatment markets today. Cervical disc replacement gained a Category I CPT code beginning in 2015 and clinical studies show efficacy when compared with fusion. Biologics are also a popular area of research and development today, with several companies investigating biological solutions for less-invasive and motion-sparing alternatives to spinal fusion.
According to a January 2014 Millennium Research Group report, the global market for spinal nonfusion will nearly triple in size through 2022, surpassing $1.6 billion. The market will be driven by emerging geographies such as the Asia Pacific, Brazil, India and China.
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