Indication for spinal surgery: associated factors and regional differences in Germany

Publikation: Beitrag in FachzeitschriftForschungsartikelBeigetragenBegutachtung


  • Falko Tesch - , Zentrum für evidenzbasierte Gesundheitsversorgung (Autor:in)
  • Toni Lange - , Zentrum für evidenzbasierte Gesundheitsversorgung (Autor:in)
  • Jochen Schmitt - , Zentrum für evidenzbasierte Gesundheitsversorgung (Autor:in)
  • Patrik Dröge - , Allgemeine Ortskrankenkasse (AOK), Research Institute Berlin (Autor:in)
  • Christian Günster - , Allgemeine Ortskrankenkasse (AOK), Research Institute Berlin (Autor:in)
  • Johannes Flechtenmacher - , German Professional Association for Orthopedics and Trauma (BVOU), Berlin, Germany (Autor:in)
  • Burkhard Lembeck - , German Professional Association for Orthopedics and Trauma (BVOU), Berlin, Germany (Autor:in)
  • Bernd Kladny - , German Professional Association for Orthopedics and Trauma (BVOU), Berlin, Germany, m&i Fachklinik Herzogenaurach (Autor:in)
  • Dieter Christian Wirtz - , German Society for Orthopedics and Trauma (DGOU), Berlin, Germany, Universitätsklinikum Bonn (Autor:in)
  • Fritz‑Uwe Niethard - , Universitätsklinikum Bonn (Autor:in)


Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases.
We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians’ specialty, conservative treatments) and regional variables were analyzed.
There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission.
This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians’ preferences.


FachzeitschriftBMC Health Services Research
PublikationsstatusVeröffentlicht - 2 Sept. 2022

Externe IDs

Scopus 85137100996
PubMed 36050682
WOS 000848877700005
Mendeley 2e9cc6e1-f486-308f-829d-8666bce5dbce
ORCID /0000-0002-8671-7496/work/142249562


Fächergruppen, Lehr- und Forschungsbereiche, Fachgebiete nach Destatis

Ziele für nachhaltige Entwicklung

ASJC Scopus Sachgebiete


  • Cohort Studies, Germany/epidemiology, Humans, Medicine, Referral and Consultation, Spinal Diseases/surgery, Back pain, Secondary data analysis, Health service research, Spinal surgery