fusions. Degeneration happens more frequently at these levels due to increased motion and stress. The thoracic spine is more immobile, so most fusions are performed due to trauma or deformities like scoliosis, kyphosis, and lordosis. Conditions where spinal fusion may be considered include the following: Degenerative disc disease Spinal disc herniation Discogenic pain Spinal tumor Vertebral fracture Scoliosis Kyphosis (e. g., Scheuermann's disease) Lordosis Spondylolisthesis Spondylosis Posterior rami syndrome Other degenerative spinal conditions Any condition that causes instability of the spine Contraindications Bone morphogenetic protein (rhBMP) should not be routinely used in any type of anterior cervical spine fusion, such as with anterior cervical discectomy and fusion. There are reports of this therapy causing soft tissue swelling, which in turn can cause life-threatening complications due to difficulty swallowing and pressure on the respiratory tract. Epidemiology According to a report by the Agency for Healthcare Research and Quality (AHRQ), approximately 488,000 spinal fusions were performed during U.S. hospital stays in 2011 (a rate of 15.7 stays per 10,000 population), which accounted for 3.1% of all operating room procedures. This was a 70 percent growth in procedures from 2001. Lumbar fusions are the most common type of fusion performed ~ 210,000 per year. 24,000 thoracic fusions and 157,000 cervical fusions are performed each year. A 2008 analysis of spinal fusions in the United States reported the following characteristics: Average age for someone undergoing a spinal fusion was 54.2 years – 53.3 years for primary cervical fusions, 42.7 years for primary thoracic fusions, and 56.3 years for primary lumbar fusions 45.5% of all spinal fusions were on men 83.8% were white, 7.5% black, 5.1% Hispanic, 1.6% Asian or Pacific Islander, 0.4% Native American Average length of hospital stay was 3.7 days – 2.7 days for primary cervical fusion, 8.5 days for primary thoracic fusion, and 3.9 days for primary lumbar fusion In-hospital mortality was 0.25% Effectiveness Although spinal fusion surgery is widely performed, there is limited evidence for its effectiveness for several common medical conditions. For example, in a randomized controlled trial of people with spinal stenosis, after 2 and 5 years there was no significant clinical benefits of lumbar fusion in combination with decompression surgery, in comparison to decompression surgery alone. This Swedish study, including 247 patients enrolled from 2006 to 2012, further found increased medical costs for those who received the fusion surgery, as a result of increased surgery time, hospital