Increasing public interest in lumbar decompression and fusion surgery in the United States: higher search volumes in the Northeast region from 2015 to 2024

Article information

Asian Spine J. 2025;.asj.2025.0133

Publication date (electronic) : 2025 August 11

doi : https://doi.org/10.31616/asj.2025.0133

Paul G. Mastrokostas^1,2, Leonidas E. Mastrokostas^1,2, Ahmed K. Emara³, Ian J. Wellington⁴, Elizabeth Ginalis⁵, John K. Houten⁶, Amrit S. Khalsa⁷, Ahmed Saleh², Jad Bou Monsef^1,2, Afshin E. Razi², Mitchell K. Ng²

¹Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

²Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA

³Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA

⁴Department of Orthopaedic Surgery, University of Connecticut, Hartford, CT, USA

⁵Department of Neurosurgery, Rutgers University, Newark, NJ, USA

⁶Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA

⁷Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA

Corresponding author: Paul G. Mastrokostas, Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA, Tel: +1-718-306-4771, Fax: +1-718-682-3847, E-mail: Pmastrokostas06@gmail.com

Received 2025 March 5; Revised 2025 April 11; Accepted 2025 April 28.

Abstract

Introduction

In the past few decades, the growing prevalence of degenerative spinal conditions has led to an increase in the number of lumbar decompression and fusion surgery procedures in the United States. In fact, the number of elective lumbar fusion surgeries for degenerative spinal diseases increased by 62.3%, from 122,679 cases in 2004 to 199,140 cases in 2015 [1]. These procedures are now among the most frequently performed surgical interventions for conditions, such as spondylolisthesis, spinal stenosis, and disc disorders [2,3]. The current situation has significant implications for healthcare resource allocation and surgical demand.

In parallel with the increased number of surgical interventions, patients have been relying on the internet for medical information. Data from multiple administrations of the Health Information National Trends Survey reveal that majority of people (69.8% to 81.5%) have searched for health or medical information online, with 68.9% reporting the internet as the first source during their most recent search [4]. This highlights the critical role of search engines in shaping healthcare-seeking behavior and public interest in medical procedures. Google Trends (Google LLC, Mountain View, CA, USA) is a freely accessible online tool that allows analysis of the popularity of search terms, making it an ideal platform for evaluating public interest in lumbar decompression and fusion surgery [5]. Previous studies have established a positive correlation between Google search volumes and actual healthcare utilization, suggesting that internet searches may serve as a proxy for patient demand [6–15].

Despite the growing use of Google Trends to assess public interest in healthcare topics, prior investigations on lumbar decompression and fusion surgery have primarily focused on short-term trends or specific events, such as the coronavirus disease 2019 (COVID-19) pandemic [6,7]. For example, Feng et al. [6] reported that within 30 days before the recommendation to halt elective surgeries during the COVID-19 pandemic, the average interest, as measured in the relative search volume (RSV), significantly increased by nearly 10%. In another study by Michel et al. [7], the RSV for search terms associated with cervical and lumbar fusion substantially declined during the peak of the pandemic and was yet to reach the prepandemic level at 4 months after removal of elective surgery restrictions in the United States. However, these studies did not examine long-term trends and seasonal and geographic variations in public interest over a sustained period.

To address this gap, this study aimed to provide a comprehensive 10-year analysis of the US public interest in lumbar decompression and fusion surgery. We investigated temporal patterns, seasonal variations, and geographic differences in search volumes using Google Trends data from 2015 to 2024. By exploring these dimensions, we sought to enhance our understanding of healthcare-seeking behavior and offer valuable insights for clinicians and healthcare administrators alike. The null hypothesis for this study was that there is no significant temporal, seasonal, or geographic variation in the US public interest in lumbar decompression and fusion surgery, as measured by Google search volumes.

Materials and Methods

Results

Temporal patterns

Throughout the study period, the search volume consistently increased across all generated models (Fig. 1), with mean absolute percentage errors ranging from 6.46% to 9.89%. Over time, the RSVs for “lumbar decompression,” “lumbar discectomy,” “lumbar fusion,” “lumbar fusion surgery,” and “lumbar spinal fusion” demonstrated significant upward trends (p<0.05 for all). The R² values ranged from 0.0141 to 0.6748. The mean RSV was highest in October at 78.8% and lowest in December at 68.7% (Table 1).

Fig. 1

(A–F) Linear trend models for “lumbar decompression,” “lumbar discectomy,” “lumbar laminectomy,” “lumbar fusion,” “lumbar fusion surgery,” and “lumbar spinal fusion” search terms. MAPE, mean absolute percentage error; MAD, mean absolute deviation; MSD, mean squared deviation.

Table 1

Monthly Google Trends search volumes for lumbar decompression and fusion

Seasonal variations

The mean RSV for lumbar decompression and fusion peaked during the fall season at 77.1% and was lowest during the winter season at 72.4%, but it did not significantly differ among the seasons (fall, 77.1% vs. spring, 75.9% vs. summer, 76.4% vs. winter, 72.4%; p=0.102) (Table 2, Fig. 2).

Table 2

Seasonal Google Trends search volumes for lumbar decompression and fusion

Fig. 2

Bar graphs depicting mean Google Trends search volumes across seasons: fall, spring, summer, and winter.

Geographic differences

The RSVs for lumbar decompression and fusion significantly varied among the major US cities (p<0.001) (Table 3). New York, NY demonstrated the highest mean RSV at 43.3% (95% confidence interval [CI], 40.4–46.2), which was significantly higher than that in all other cities. Los Angeles, CA had a higher mean RSV (19.5%; 95% CI, 17.5–21.6) than Chicago, IL (12.6%; 95% CI, 11.2–14.1); Houston, TX (11.1%; 95% CI, 9.26–12.9); and Phoenix, AZ (10.2%; 95% CI, 8.26–12.1). In addition, Chicago, IL had a significantly higher mean RSV than Phoenix, AZ, as indicated by the nonoverlapping confidence intervals (Fig. 3).

Table 3

Google Trends search volumes for lumbar decompression and fusion by major city

Fig. 3

Bar graphs depicting mean Google Trends search volumes across major cities in the United States: Chicago, IL; Houston, TX; Los Angeles, CA; New York, NY; and Phoenix, AZ.

Discussion

With the increasing demand for elective lumbar fusion surgery, we used Google Trends to explore the temporal, seasonal, and geographical aspects of US public interest in lumbar decompression and fusion surgery. Over a 10-year period, we observed a consistent upward trend in the RSV for “lumbar decompression,” “lumbar discectomy,” “lumbar laminectomy,” “lumbar fusion,” “lumbar fusion surgery,” and “lumbar spinal fusion.” Public interest peaked in the fall, with the monthly RSV being highest in October and lowest in December. Although seasonal fluctuations were observed, the differences were not significant. Regionally, the northeast exhibited the highest level of public interest and the southwest recorded the lowest RSV. These trends suggested that public engagement in lumbar fusion and decompression may reflect broader patterns of regional healthcare access, awareness, and demand.

We observed an upward trend over time in the RSV for the key search terms in this study. Although no studies have evaluated long-term trends in public interest in lumbar decompression and fusion surgery, this observation was consistent with previously reported trends in neurosurgical procedures after the COVID-19 pandemic. A study by Feng et al. [6] revealed increased public interest, consistent with prepandemic trends, in all neurosurgical procedure categories after the removal of elective surgery restrictions and implementation of official reopening measures across the country. However, that study focused on the most popular spine-related search terms, such as “spinal fusion” and “laminectomy” [6]. The study by Feng et al. [6] provided insights based on a relatively short timeframe of assessing increased interest in spinal procedures after the pandemic, whereas our study highlighted a long-term increase in interest in lumbar decompression and fusion. Our findings may contribute to understanding the evolving trends in postpandemic interest in spinal procedures and reflected a relatively broad and long-term interest in these interventions.

We observed modest fluctuations in the seasonality of public interest in lumbar decompression and fusion, with the highest level observed in the fall and lowest in the winter. However, these seasonal differences were not significant. Although no studies have specifically examined the relationship between seasonality and elective spinal procedures, such as lumbar decompression and fusion, the interplay between seasonality and other elective procedures has been investigated. Shmelev et al. conducted a study using a Nationwide Inpatient Sample database of 18,050,726 elective general surgery procedures from 1988 to 2019 and found that summer months had peaks in appendectomy and cholecystectomy procedures [16]. Ng et al. [17] reported that complication rates after total hip or knee arthroplasty were higher during summer months than during winter months, potentially due to factors, such as new resident trainees in academic hospitals in summer. This underscored the potential impact of seasonal factors on healthcare-seeking behavior and offered physicians and hospital administrators valuable insights into possible healthcare demands during high-volume months or seasons.

We identified notable regional variations in public interest in lumbar decompression and fusion among major US cities. Compared with other regions, the northeast had the highest level of public interest. The West demonstrated moderate levels of interest, followed by the Midwest and South, whereas the Southwest recorded the lowest engagement. These patterns closely paralleled the findings of Moore et al. [18], who evaluated workforce trends in spinal surgery and found regional disparities in the availability of neurologic and orthopedic spine surgeons. During their study period, the number of spine surgeons substantially increased to 11.7% in the South and 17.8% in the Northeast and modestly increased to 4.8% and 5.8% in the Midwest and West, respectively [18]. These disparities in workforce availability may help explain the regional variation in public interest we observed. Areas with higher concentrations of spine specialists may naturally generate more patient engagement and health-related searches, whereas regions with fewer resources may lag in visibility and access. These findings highlighted the importance of aligning healthcare planning and resource allocation with public demand, particularly in high-growth regions.

Although our findings were robust, alternative explanations must be considered to comprehensively understand the observed trends. The upward trend in public interest may have reflected an increase in lumbar spine surgeries and could have been influenced by greater public awareness through media coverage, public health campaigns, or changes in insurance policies, which have made spinal procedures more accessible or visible. Moreover, broader internet access and increased use of online resources for health information over the last decade may have contributed to the increase in search volumes. Geographic differences may have been influenced by disparities in healthcare access. Regions with higher concentrations of spine specialists and healthcare resources may have better patient engagement in health-related information, whereas areas with fewer healthcare resources may have reduced search volume for elective surgeries, such as lumbar fusion. Seasonal variations could have been affected by factors, such as elective surgery scheduling, patient behavior during holidays, and changes in healthcare system capacity, which may influence the timing of seeking or planning medical procedures.

This study had some limitations. Although Google Trends offers valuable insights into public interest in medical procedures and captures approximately 90% of the internet search traffic, it cannot account for searches on “lumbar decompression,” “lumbar discectomy,” “lumbar laminectomy,” “lumbar fusion,” “lumbar fusion surgery,” and “lumbar spinal fusion” in other search engines [19]. In addition, not all search terms in this study provided state-specific data; therefore, mean RSVs were calculated based on the available search terms for a given state. Google Trends lacked demographic data of the internet users included in this study, making it challenging to determine whether the sample represented the entire US population. Furthermore, changes in healthcare policy, insurance reimbursement, and population demographics over the study period, as well as regional differences in healthcare access, could have influenced search behaviors. These factors, along with the lack of correlation between search volume and actual surgical volume, limit the conclusions on healthcare utilization based on search trends alone. Finally, although RSV was used to measure public interest in lumbar decompression and fusion, a direct connection between this interest and actual performance of these procedures cannot be established. Future studies should correlate search data with clinical data to provide more definitive insights into healthcare-seeking behavior.

Conclusions

Our study reflected a 10-year sustained and growing public interest in lumbar decompression and fusion surgery, with the highest rate observed in the northeast and lowest in the southwest. These patterns paralleled the known disparities in spine surgeon availability and highlighted the importance of aligning healthcare planning with regional demand. Overall, this study offered insights into how geographic factors shape public interest in lumbar spine surgery and underscored the need for regionally tailored strategies for healthcare delivery. Future research should further investigate the influence of sociodemographic variables, such as income, education, and employment, to better understand evolving trends in spine care engagement.

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