Cram P, Landon BE, Matelski J, et al. - Spine surgery utilization, among all patients and prespecified patient subgroups, was compared between the province of Ontario and the state of New York. Researchers analyzed data of all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes in Ontario (years 2011–2015) and in New York (2011–2014). Relatively older patients in Ontario vs New York underwent both decompression (mean age 58.8 vs 51.3 years) and fusion (58.1 vs 54.9). Decompression (26.1% vs 54.9%) or fusion (15.2% vs 56.7%) is performed by a smaller percentage of hospitals in Ontario vs New York. Overall, utilization of spine surgery (decompression plus fusion) in Ontario and in New York was 6.6 procedures per-10,000 population per year vs 16.5 per-10,000 per year, respectively. For emergent cases, they observed smaller Ontario-New York differences in utilization, however, the differences were larger for elective cases (4.6 vs 13.9). Particularly younger patients (age < 60 years) largely showed lower utilization in Ontario.