Trends in spinal implant utilization and pricing.

Abstract

Introduction: The escalation of United States (U.S.) spine surgery volume has been accompanied by considerable advancements in our understanding of spine physiology and technology. Together with implant development over the past decades, these improvements have led to shifts in implant usage. This investigation aimed to elucidate the trends in spinal implant utilization in the U.S. from 2013 to 2022.

Materials and methods: Spine implant utilization and pricing averages between 2013 and 2022 were extracted from Orthopedic Network News. The total sample composed of 664,310 spine procedure purchase orders. Prices were adjusted for inflation based on 2022 prices. Trends were analyzed using linear regression.

Results: The U.S. spine procedure volume increased significantly from around 800,000 procedures per year in 2013 to over 1.1 million in 2022, with 73% comprising lumbar and cervical fusions. The proportion of procedures performed in patients over 64 years old increased significantly in both lumbar and cervical cases, constituting 50% and 37% of procedures, respectively. In lumbar spine in 2022, 46% of procedures utilized both pedicle screws (PSs) and interbody devices, 37% PSs only, and 13% interbody devices only. Lumbar PS price decreased significantly to $923 each despite stable lumbar and cervical fusion procedure costs. Polyetheretherketone (PEEK) and allograft interbody device usage declined while metal increased significantly.

Conclusion: Nationwide spine procedure volume rose notably from 2013 to 2022, with the majority constituting lumbar and cervical fusions. The most frequent treatment for a lumbar fusion is a PS construct with an interbody fusion device. Interbody fusion device materials witnessed decline in the use of PEEK and allograft, with metals becoming the preferred material.

Level of evidence: III.