About

Dr. Darrel S. Brodke is the Chair of the Department of Orthopaedics at the University of Utah and holds the Jack and Hazel Robertson Presidential Endowed Professorship. He is a spine specialist focused on improving pain and function for individuals with spinal disorders through both surgical and non-surgical treatments. His expertise includes the care of neck and back problems, such as disc herniations, spinal stenosis, and degenerative conditions. Dr. Brodke's research interests have concentrated on spinal biomechanics, spinal deformity surgery treatments, and patient-reported outcomes, with the aim of advancing and broadening care through his work. He received his MD degree from the University of California, San Francisco, completed an Orthopaedic Residency at the University of Wisconsin, and a Fellowship in Spine Surgery at the University of Washington in Seattle. Since joining the faculty of the University of Utah in 1997, he has established himself as a highly regarded expert in his field, known for his skill, compassion, and dedication to patient care and education.

Research topics

• Medicine
• Surgery
• Intensive care medicine
• Anesthesia
• Internal medicine
• Physical therapy
• Physical medicine and rehabilitation
• Clinical psychology
• Medical physics

Selected publications

• Cost and Utilization Trends of Lumbar Fusion

  JAMA Network Open · 2026-03-04 · 1 citations

  articleOpen accessSenior author

  Importance: The increasing cost of lumbar fusion has invited payment reforms, such as mandatory price limits by Medicare in 2026. Objective: To examine the cost, utilization, and procedural case-mix trends for different types of lumbar fusion from 2002 to 2023 in the United States. Design, Setting, and Participants: This cross-sectional analysis used survey-weighted data from the 2002 to 2023 National Inpatient Sample (NIS) and the 2016 to 2022 Nationwide Ambulatory Surgical Sample (NASS). From this nationally representative sample of inpatient and hospital-owned outpatient discharges, information on US adults aged 20 years and older undergoing lumbar fusion for any indication from January 2002 to December 2023 were included. Exposures: Lumbar fusion of any type (1-disc level or multilevel as well as single vertebral column or both anterior-posterior columns) with nonfusion surgery as a comparison. Main Outcomes and Measures: The main outcomes were the survey-weighted annual total of procedures, the mean age of patients undergoing lumbar fusion, the inflation-adjusted hospital costs, and the annual procedure rates per 100 000 population. Results: A total of 5 033 772 lumbar fusion admissions between 2002 and 2023 were included. In 2023, the cohort of patients undergoing 274 750 procedures had a mean (SD) age of 63.2 (12.9), with 142 815 (52.0%) female patients. Excluding 54 620 complex fusions, which were mostly multilevel anterior-posterior column fusions, there were 164 105 (50.1%) multilevel fusions, and 109 130 (51.3%) combined anterior-posterior column fusions. The age-adjusted population rate of inpatient fusion procedures increased from 60.1 (95% CI, 58.8-90.3) per 100 000 in 2002 (148 823 admissions) to a peak of 89.9 (95% CI, 89.6-90.3) in 2016 (284 180 admissions), before declining to 80.0 (95% CI, 79.7-80.4) by 2023 (273 235 admissions). Lumbar fusion performed in hospital-owned outpatient facilities was minimal in 2016 (6132 procedures, or 2.1% of total lumbar fusions) and 6.9 per 100 000 (27 331 procedures, or 9.8% of total lumbar fusions) in 2022. Adjusted inpatient hospital costs increased 265.3% from $3.86 (95% CI, $3.81-$3.92) billion in 2002 to $14.1 (95% CI, $13.9-$14.2) billion in 2023, and mean inpatient per-procedure cost increased from $25 849 (95% CI, $25 684-$26 015) in 2002 to $45 458 (95% CI, $45 207-$45 709) in 2023. Lumbar fusion primarily shifted from single column at 1 or 2 disc levels in 2002 (mean cost, $24 515; 95% CI, $24 361-$24 669) to multilevel anterior-posterior column fusion in 2023 (mean cost, $55 034; 95% CI, $54 420-$55 650). Conclusions and Relevance: In this cross-sectional study, lumbar fusion trends were marked by greater utilization of procedures overall, and especially involving multilevel and combined anterior-posterior column approaches and by greater use in the outpatient setting. Costs also increased at both the national and per-procedure levels.

  PublisherOA PDFDOI

• The Impact of PROMIS Physical Function Scores on Healthcare Resource Utilization in Patients Treated for Chronic Mechanical Low Back Pain

  Interventional Pain Medicine · 2025-01-01

  articleOpen access
  PublisherDOI

• Narrative Review of Perioperative Glucagon-like Peptide-1 (GLP-1) Agonists in Spine Surgery

  Clinical Spine Surgery A Spine Publication · 2025-07-17 · 1 citations

  articleCorresponding

  Spine surgeons are increasingly likely to encounter patients taking glucagon-like peptide-1 (GLP-1) receptor agonists for glycemic control and/or weight loss. GLP-1 receptor agonists present an attractive option for helping patients meet hemoglobin A1C and body mass index goals before elective surgeries and have already been implemented for these purposes. It is imperative for spine surgeons to understand the potential risks and benefits of these drugs during the perioperative period and their influence on patient outcomes. This review provides an overview of the history of GLP-1 receptor agonists, their mechanism of action and efficacy as a diabetic and weight loss treatment, as well as the clinical relevance to the field of spine surgery. Further studies are required to truly understand the impact of these medications on spine surgery and in the management of these patients in the perioperative period.

  PublisherDOI

• Comparing Complications and Costs of Anterior Cervical Discectomy and Fusion in the Inpatient, Outpatient, and ASC Settings in the Medicare Population

  Spine · 2025-11-07

  article

  STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The aim of this study was to compare differences in post-operative readmission rates, complications, and costs for 1-2 level ACDFs among Medicare fee-for-service beneficiaries performed in an inpatient, hospital outpatient, or ASC. SUMMARY OF BACKGROUND DATA: Anterior cervical discectomy & fusion (ACDF) is increasingly performed in the outpatient setting. There is a paucity of literature examining the safety and differences in cost of performing these procedures in the outpatient setting. METHODS: Patients who underwent a primary one- or two-level ACDF from 2016-2021 were retrospectively identified using Current Procedural Terminology (CPT) codes. A total of 118,692 patients were included in the analysis. Demographic data, surgical characteristics, post-operative readmissions and complications, as well as cost data were collected through Centers for Medicare and Medicaid Services. Patients were matched by demographic, comorbidity, and surgical characteristics, and univariate analysis was performed to determine differences in outcomes by surgical setting. RESULTS: The proportion of Medicare patients undergoing ACDF at a hospital outpatient or ASC steadily increased from 2016-2021, ultimately as high as 49.2% in 2021. Total adjusted initial ("index") surgery (ASC $9,898 vs. OP $13,011 vs. IP $33,911) and total 90-day episode of care costs (ASC $13,465 vs. OP $17,264 vs. IP $44,016) were significantly lower in both the ASC and outpatient cohorts compared to the inpatient cohort (P<0.001). ACDF's performed in the ASC or outpatient setting had significantly lower rates of adjusted readmission, total complications, infection, VTE, and revision surgery (P<0.001) compared to those in the inpatient setting. CONCLUSION: One- and two-level ACDF is increasingly being performed in an outpatient setting. Outpatient surgery is associated with lower rates of readmission, complications, and costs. By using the Medicare database and matching patients by demographic data and comorbidities, the results support performing ACDFs at an ASC is safe. LEVEL OF EVIDENCE: III.

  PublisherDOI

• Advancing Digital Access to Physical Therapy via Virtual and Extended Reality Technology: Prototype Development and Usability Evaluation

  JMIR Formative Research · 2025-12-05

  articleOpen access

  Background: The United States faces significant challenges in physical therapy (PT) access due to high demand, a shortage of professionals, and patient-related obstacles, which can adversely affect recovery and function. Limited access to PT may lead to increased dependence on medications for pain management, highlighting the need for nonpharmacologic options to reduce opioid overprescribing. Low back pain, a leading cause of disability and high medical costs, is a common reason for requiring PT following surgery. Studies have shown that virtual reality (VR)-guided movements can improve motor function and reduce pain intensity. Objective: The objective of this study was to design, develop, and evaluate a VR-based prototype for individualized postoperative PT for patients recovering from back surgery to investigate its potential to improve convenience, access, and health outcomes in future research. Methods: Study methods involved participatory design and development of VR software for PT back exercises using the design box method, an inductive, problem-oriented collaborative design approach. A usability evaluation of the resulting prototype was conducted with patients recovering from back surgery using a think-aloud protocol and usability survey. Results: Six participants evaluated the VR prototype and reported usability challenges that included mismatched VR boundaries, limited familiarity with VR, and difficulties with the headset and hand controls. The System Usability Scale resulted in a total usability score of 58.3 out of 100, indicating a below-average score (68 being average). Conclusions: In the design and evaluation of a VR-based PT prototype, we found that while participants were enthusiastic, they faced usability challenges due to insufficient instructions and difficulties operating the VR device, highlighting the need for effective onboarding and extensive prototype testing to improve accessibility and engagement in health care. Future evaluations will investigate disparities among different groups to ensure accessibility and effectiveness for all users.

  PublisherDOI

• The sodium-glutamate antagonist riluzole improves outcome after acute spinal cord injury: results from the RISCIS randomised controlled trial analysed using a global statistical analytic technique

  EBioMedicine · 2025-07-24 · 8 citations

  articleOpen access

  BACKGROUND: Spinal cord injury (SCI) clinical trials typically rely on a single primary endpoint to assess drug efficacy. This strategy fails to adequately capture the full impact of treatment in heterogenous neurological conditions like SCI. A more patient-centric analysis requires assessment of neurological function, functional capacity, and quality of life, incorporating meaningful patient-reported outcomes. The global statistical test (GST) addresses this challenge using a unified statistical conclusion regarding the superiority of a treatment strategy over another by evaluating multiple trial endpoints simultaneously. METHODS: The RISCIS trial (Safety and Efficacy of Riluzole in Acute Spinal Cord Injury Study) data was analysed using a multivariate nonparametric GST, integrating the total American Spinal Injury Association (ASIA) motor score (TOTM), Spinal Cord Independence Measure (SCIM), and SF-36 PCS (Short Form-36 Physical Component Scale) scores. In the RISCIS trial, patients with severe cervical SCI (AIS A, B, and C) were randomised to receive riluzole or placebo within 12 h of injury in a double blinded fashion. We compared six-month outcomes between groups using a modified O'Brien's rank sum test with sample variance adjustment. Higher summed ranks represent better global outcomes. The overall probability of improvement was computed using a summary estimate, the global treatment effect (GTE). FINDINGS: A total of 131 patients (mean age 45.8 years old, 82% males) completed the six-month outcome assessment. Among these, 49.6% were classified as AIS A, 20.6% as AIS B, and 29% as AIS C. Riluzole was administered within 12 h from injury for 14 days in 65 patients, while 66 received a placebo. The unadjusted mean change from baseline to six months showed a favourable response in the riluzole group compared to placebo across TOTM (p = 0.28 by t-test; p = 0.26 by Wilcoxon test), SCIM (p = 0.04 by t-test; p = 0.02 by Wilcoxon test), or SF-36 PCS (p = 0.23 by t-test; p = 0.21 by Wilcoxon test) scores. Using the GST to simultaneously assess these measures, the riluzole group exhibited a higher rank sum compared to placebo [median rank sum = 207 (IQR: 166-246) in riluzole vs 185 (IQR: 146-236) in placebo, p = 0.04]. Subgroup analysis revealed the greatest treatment benefit among patients with AIS A injuries (GTE = 0.16, 95% CI: 0.01-0.31, p = 0.02). At six months, the probability that riluzole treatment resulted in overall better outcomes than placebo across all assessed outcomes was 58%. INTERPRETATION: Riluzole was associated with improved global outcomes in patients with severe traumatic SCI, based on a composite score integrating ASIA total motor scores, SCIM, and SF36 outcomes at six months. Riluzole is a promising therapeutic option in SCI, but further investigation through higher-quality studies incorporating multidimensional assessments is warranted. FUNDING: No funding was received for the present work. The original clinical trial (NCT01597518) was funded by the AO Foundation, United States Department of Defense (DOD), and the Praxis Spinal Cord Institute.

  PublisherOA PDFDOI

• Predictors of Full-Time Spine Surgeon Faculty Position at a University Hospital

  Journal of the American Academy of Orthopaedic Surgeons · 2025-06-24

  article

  INTRODUCTION: Although spine surgery careers are influenced by a multitude of professional and personal factors, predictors of career trajectories and future research effect may be identifiable at the spine fellow applicant stage. As such, this study aimed to (1) determine factors predictive of University Hospital [UH] employment and research contributions and (2) compare the application metrics identified as most important to an academic career by spine surgery program directors (PD) to those predictive of career environments from prior spine fellows applications. METHODS: All applications of individuals applying for spine fellowship training between 2017 and 2021 at an academic institution were reviewed. Application metrics pertaining to research achievement, academic achievement, prior and current education, extracurricular involvement, leadership, examination scores, applicant interests, and letter of recommendation (LOR) reputation were extracted. The careers of all prior spine fellow applicants were grouped by the presence or absence of full-time university appointment and research effect (current H-index). A survey sent to spine PDs asked them to rank the importance of application factors to academic careers using analogous metrics to the application review. RESULTS: A total of 310 applications were reviewed. Residency publications (odds ratio [OR]: 1.09, P = 0.0116), preclinical publications (OR: 1.24, P = 0.0447), and expressed academic interest (OR: 2.25, P = 0.0229) predicted UH appointment. Applicant physician scientist interest (β: 2.41, P < 0.001), LOR writers' reputation (β: 0.05, P < 0.001), and journal reviewer positions (β: 0.80, P < 0.001) predicted current H-index. In the PDs survey, metrics predicting academic trajectory were ranked (descending): research achievements, physician scientist interest, academic interest, leadership positions, LOR writers' reputation, prestige of training, and United States Medical Licensing Examination scores. Research year(s), advanced degrees, and society leadership and membership positions, although theoretically deemed important by PDs, were in actuality minor contributors to the career environments of spine fellow applicants. CONCLUSION: Spine fellow academic interest, residency publications, and preclinical publications predicted full-time UH-based careers. LEVEL OF EVIDENCE: 3. STUDY DESIGN: Retrospective Cohort Analysis.

  PublisherDOI

• P17. Anterior cervical discectomy and fusion in the ambulatory surgery center versus outpatient and inpatient settings in a Medicare population: an analysis of complications and cost

  The Spine Journal · 2025-10-09

  article
  PublisherDOI

• P142. A multi-center prospective comparative study of circumferential versus posterior surgical treatment for lumbar isthmic spondylolisthesis (I-Spondy Trial)

  The Spine Journal · 2025-10-09

  article
  PublisherDOI

• Effect of the Comprehensive Addiction and Recovery Act (CARA) on Buprenorphine Prescribing for Opioid Use Disorder Among Medicare Beneficiaries With Back Pain

  Spine · 2025-05-01

  article

  STUDY DESIGN: Observational cohort study. OBJECTIVE: To examine the effects of the Comprehensive Addiction and Recovery Act (CARA) on buprenorphine prescribing and opioid use disorder (OUD) among Medicare beneficiaries with back pain. SUMMARY OF BACKGROUND DATA: Enacted in January 2017, CARA extended buprenorphine prescribing authority to Nurse Practitioners (NP) and Physician Assistants (PA) to treat OUD, defined as a physical or psychological dependence on opioids, but adoption varied by state. Leveraging this policy variation, we examined the effect of CARA on buprenorphine prescribing and OUD employing Medicare beneficiaries over age 65 with back pain from 2016 to 2019, and who were eligible for Part D prescription drug benefits. Only buprenorphine and buprenorphine/naloxone combinations that are FDA-approved for OUD treatment were included as our outcome. MATERIALS AND METHODS: A difference-in-difference regression examined the change in buprenorphine prescribing and OUD before and after CARA between states that did and did not expand prescription authority. Subgroup analysis examined treatment effect heterogeneity by sex and race/ethnicity. RESULTS: States that adopted a full scope-of-practice under CARA had a significant increase in buprenorphine prescribing (6.5%, 95% CI: 1.3%, 12.2%) and a reduction in OUD (7.2%, 95% CI: -9.3%, -4.8%) compared with states that did not expand prescribing authority after the policy implementation. States that expanded prescribing authority following CARA had a disproportionate increase in use of buprenorphine and a reduction in OUD among males and Hispanic patients compared with female and White patients. The magnitude of the policy effects increased over time across all groups. CONCLUSIONS: CARA was associated with increased buprenorphine prescribing and a reduction in OUD among older adults with back pain. Expanded authorization of prescription of buprenorphine to treat OUD by NPs/PAs in states that have not adopted full scope-of-practice under CARA might effectively reduce OUD, as well as racial/ethnic disparities in buprenorphine prescribing and OUD. LEVEL OF EVIDENCE: Level 3.

  PublisherDOI

Frequent coauthors

• Brandon D. Lawrence

  365 shared

• Michael G. Fehlings

  University of Toronto

  350 shared

• Paul M. Arnold

  Carle Foundation Hospital

  294 shared

• Christopher I. Shaffrey

  Duke University

  260 shared

• Alan S. Hilibrand

  Rothman Institute

  252 shared

• Jens R. Chapman

  Swedish Medical Center

  230 shared

• K. Daniel Riew

  Columbia University

  221 shared

• Mark B. Dekutoski

  The Core Institute

  217 shared

Education

• M.D.

  University of California, San Francisco

• Other

  University of Wisconsin

• Other

  University of Washington in Seattle

• Other

  University of Utah

  1997

Awards & honors

• Jack and Hazel Robertson Presidential Endowed Professorship