Physicians who perform the most unnecessary back surgeries—what we know

By Judith Garber | October 29, 2025

The Lown Institute’s latest report on back surgery overuse examines the prevalence of unnecessary spinal fusion and vertebroplasty at U.S. hospitals. We found that more than 200,000 unnecessary back surgeries took place across three years, costing Medicare more than $1.9 billion. But what about the physicians responsible for this overuse? Let’s take a look at the data to see what we can learn.

Physician overuse scenarios

Sometimes doctors working at the same hospital have substantially different rates of overuse. In these cases, it appears overuse is not a cultural phenomenon of the hospital, but a tendency unique to each physician.

At a hospital in Illinois, for example, two doctors performed a similar number of spinal fusions/laminectomies (fusing together or removing vertebrae to treat back pain). But for one of them we deemed the majority (60%) as overuse, while for the other, the substantial majority were appropriate.

Illinois hospital spinal fusion overuse, by physician

	Total # spinal fusions	Overuse # spinal fusions	Overuse rate
Doctor 1	188	112	60%
Doctor 2	181	45	25%

At a hospital in New York state, four physicians conducted at least 70 spinal fusions, but they had varying rates of overuse, from 16-61%.

New York hospital spinal fusion overuse, by physician

	Total # of spinal fusions	Overuse # spinal fusions	Overuse rate
Doctor 1	273	166	61%
Doctor 2	110	20	18%
Doctor 3	87	17	20%
Doctor 4	74	12	16%

In another scenario, we find that one doctor is responsible for most spinal fusions performed at a hospital, and that doctor also has a high rate of overuse. In these cases, patients are almost guaranteed to see a doctor with a high rate of overuse.

At this hospital in Pennsylvania, for example, one physician performed the majority of spinal fusions and had an overuse rate that exceeded 50%, for a total of 281 spinal fusions that met criteria for overuse.

Pennsylvania hospital spinal fusion overuse, by physician

	Total # spinal fusions	Overuse # spinal fusions	Overuse rate
Doctor 1	473	281	59%
Doctor 2	<11	<11	n/a
Doctor 3	<11	<11	n/a

We also see outlier physicians when it comes to unnecessary vertebroplasty (injecting medical-grade cement to treat compression spinal fractures). At four of the twenty hospitals with the highest rates of overuse, there is one doctor performing the majority of the hospital’s vertebroplasty overuse.

	Outlier doctor overuse	% of hospital overuse done by outlier doc
Hospital 1	208	70%
Hospital 2	279	86%
Hospital 3	262	69%
Hospital 4	239	96%

Outliers make up the majority of overuse

According to our data, a minority of doctors are responsible for the majority of spinal fusion overuse. Of the 6,000 doctors that performed any spinal fusions, 4,000 of them had zero surgeries that met criteria for overuse. That leaves the 71,000 unnecessary spinal fusions we identified attributable to just 2,000 physicians, with the top 600 overuse doctors responsible for the vast majority.

# of Doctors	Overuse # spinal fusions
600	43,000
1,400	28,000
4,000	0

Similarly, for vertebroplasty, while there were about 2,000 doctors in our data set that performed at least one unnecessary vertebroplasty, the top 10% by volume performed about a third of the total.

Which states are home to the most prolific overusers?

We identified more than 30 doctors who are outliers when it comes to spinal fusion overuse. They performed at least 100 procedures that met criteria for overuse and had overuse rates of 50% or higher, meaning that every other spinal fusion they did was likely unnecessary. Alabama is home to five of these physicians.

We also found 43 doctors who were outliers in performing vertebroplasties. They did at least 100 vertebroplasties meeting overuse criteria over three years, and performed at least 50% of the total vertebroplasties at a high-overuse hospital. These doctors are clustered in the Midwest and South, with the most in Ohio, Florida, Arkansas, Illinois.

Why is it that some doctors have much higher overuse rates than others? How can we encourage more responsible practice patterns when it comes to back surgeries? We’ll be covering this topic in a future blog, so stay tuned!

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.