Lumbar disc replacements have been available in the U.S. for more than a decade, but a new article in Clinical Spine Surgery examines why they haven't become a common procedure.
Here are five key trends from the report:
1. From 2005 to 2010, the number of lumbar total disc replacements decreased from 3,650 to 1,863. At the same time, revision lumbar disc replacements increased from 420 to 299.
2. In a survey of 613 spine surgeons, 51.1 percent reported they'd performed lumbar total disc replacement.
3. Most of the 14 largest insurers — 78.6 percent — don't cover lumbar total disc replacements. Sixty-five percent of the surgeons surveyed said there was a lack of insurance coverage for the procedure in their region.
4. Of the procedure's early adapters, 44.6 percent continue to perform lumbar total disc replacement.
5. Among those currently performing lumbar total disc replacement, 81.5 percent are satisfied with the results. Half of the surgeons surveyed worry about long term complications and technical challenges of revision.
"A primary reason for this failure [of widespread adoption] seems to be lack of insurance coverage, despite intermediate-term clinical success," concluded the study authors. "In addition, surgeons continue to express concerns regarding long-term outcomes and technical difficulties of revision. This case study of failed surgical innovation may signal increasing involvement of payers in clinical decision-making and may be instructive to surgeons, policymakers and manufacturers."