A Massive Increase in Outpatient Spinal Surgery

How common is spinal surgery? The answer is that it is a lot more common than it used to be. Researchers found that between 1994 and 2006, the number of spinal procedures for intervertebral disc disorders increased by 540% or 5.4 times. Intervertebral disc disorders include conditions such as disc herniation or degenerative disc disease. Over that same period, the frequency of surgery for spinal stenosis rocketed an impressive 926%, which is more than a ninefold increase.

A major shift from hospital-based to outpatient spinal surgery

The data from the Centers for Disease Control and Prevention show a shift from surgeries performed in a hospital setting to those performed in an ambulatory surgical center. Spine surgeons in the United States performed spinal stenosis surgery in an ambulatory center a whopping 20 times more often in 2006 than they did in 1994.

Why is spinal surgery so much more common?

Spinal stenosis surgery and surgery for intervertebral disc disorders are much safer than they were even 20 years ago. Newer spinal surgery methods and techniques have greatly increased success rates and patient satisfaction. Numerous scientific studies were published during this time showing that surgical intervention is superior to non-operative management for patients with failed conservative non-operative care. In other words, physicians in the late 90s were realizing surgery was superior to physical therapy for lumbar disc herniation and spinal stenosis.

Radiological imaging techniques also became more common and less expensive between 1994 and 2006. This means that people were much more likely to obtain an MRI of the lower spine than they were in the past. This increase in the frequency of imaging may reveal pathology in the spine requiring surgical correction. An MRI in the mid-1990s could cost more than $10,000, which made patients hesitant to have the study done and insurers less likely to fully pay for it. Ten years later, an MRI is still not cheap, but far less expensive than it was previously. Moreover, health insurers are more inclined to pay for the study than they once were.

Why outpatient spinal surgery?

Outpatient spinal surgery confers several advantages over surgery conducted in a hospital. Perhaps the most fundamental advantage is that ambulatory/outpatient surgical procedures are substantially less expensive than those performed in a hospital. This has made ambulatory spinal surgery more attractive for patients (lower copayment) and health insurers (lower cost of reimbursement). The only conceivable drawback is that patients must be transferred to a hospital in the event of a surgical complication. Fortunately, the risk of this happening with routine outpatient spinal surgery procedures is exceedingly small.

Health insurers, patients, and even spine surgeons prefer ambulatory surgical centers over hospital settings because they are less cumbersome, have less bureaucracy, and lower overhead costs. Surgeons are usually happier to perform surgery in an outpatient surgery center that they own because they can avoid paying overhead costs to a hospital for minimal added benefit.

Is spinal surgery right for you?

When it comes to your care, it really does not matter how common spinal surgery has become or that it will most likely be performed in an ambulatory surgical center. What matters is whether spinal surgery is right for you. If you are considering spinal surgery, it helps to know that it is safer and more effective than it was two or three decades ago. Likewise, the costs associated with the surgery are lower than they once were. Finally, outpatient spinal surgery is often less expensive for you and your health insurer. In the end, everyone wins.


  1. Best MJ, Buller LT, Eismont FJ. National Trends in Ambulatory Surgery for Intervertebral Disc Disorders and Spinal Stenosis: A 12-Year Analysis of the National Surveys of Ambulatory Surgery. Spine (Phila Pa 1976). 2015;40(21):1703-1711.

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