According to the Journal's analysis, 38% of those fusions were performed on patients with aging disks.
Thomas Jefferson ranked No. 4 among hospitals that perform the highest proportion of complex fusions.
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The number of lumbar fusions, to name one procedure, tripled from 1990 to 2001, reaching 120, 000 that year.
Some of the inventions included devices that aid in spinal fusions and a plate used in neck surgery.
Complex fusions increased 15-fold among Medicare beneficiaries with spinal stenosis from 2002 to 2007, according to the JAMA study.
Based on the Journal's analysis, Dr. Vaccaro's hospital performed 1, 177 spine fusions on Medicare beneficiaries from 2004 to 2008.
Roughly four-fifths of fusions succeed, but only two-thirds start down the path of development that leads to a new individual.
For surgeons, the financial incentives to perform spine fusions can be strong.
He says that insurer UnitedHealthcare is working to limit spine fusions and that some hospitals may too, because the surgeries are so expensive and unproven.
Using the Medicare-claims database, the Journal found this surgeon performed 276 spinal fusions on Medicare patients in 2008, by far the most of any surgeon in the country.
As many as 20% of spinal fusions are for ordinary low back pain and may not be supported by good evidence, says Derrick Sung, an analyst at Sanford C.
Complex fusions, the procedure studied in the JAMA paper, are reimbursed by Medicare at a sharply higher rate than decompressions, to account for the elaborate spinal devices used and the longer length of surgery.
Cultivating good relations with surgeons like Dr. Vaccaro is valuable to device makers because they often perform more than 100 spine fusions a year and use thousands of dollars of implantable devices during each surgery.
At the annual meeting of the American Academy of Orthopaedic Surgeons in Las Vegas in February 2009, Norton's Dr. Glassman presented a study on lumbar fusions that showed a significant improvement in fused patients' back pain, leg pain and other quality-of-life measures, both one and two years after their surgery.
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