Background Spinal fusion is a well-established procedure in the treatment of degenerative spinal diseases. Previous research shows that the use of this operative treatment has been growing in recent decades in industrialized countries and has become one of the most cost-intensive surgical procedures. It seems that in some countries such as Germany—with its large, industrialized, European population—this increase is mainly driven by demographic changes with low fertility rates, increasing life expectancy, and an aging population. Based on current projections, however, Germany faces a population trend that many other countries are likely to follow within a few decades. An increasingly shrinking and aging working population may eventually put the healthcare system under enormous pressure, with greater demands for spinal fusions and associated higher costs. Thus, we aimed to provide reliable projections regarding the future demand for posterior spinal fusion procedures including age- and gender-related trends up to 2060, which will be necessary for future resource planning and possible improvements in actual treatment strategies. Questions/purposes (1) How is the use of posterior spinal fusions in Germany expected to change from 2019 through 2060, if currents trends continue? (2) How is the use of posterior spinal fusions in Germany expected to change depending on patients’ age and gender during this time period? Methods Comprehensive nationwide data provided by the Federal Statistical Office, the official institution for documenting all data on operations and procedures performed in Germany, were used to quantify posterior spinal fusion rates as a function of calendar year, age, and gender. Because there is a lack of evidence regarding future trends in the use of posterior spinal fusions, an autoregressive integrated moving average model on historical procedure rates from 2005 to 2019 in relation to official population projections from 2020 to 2060 was chosen to forecast future absolute numbers and incidence rates of this procedure in Germany. Long-term forecasting is more prone to unexpected disruptions than forecasting over short-term periods; however, longer spans facilitate estimates of how trends may challenge future healthcare systems if those trends continue, and thus are useful for research and planning. Results The incidence rate of posterior spinal fusion was projected to increase by approximately 83% (95% CI 28% to 139%) to 102% per 100,000 inhabitants (95% CI 71% to 133%) in 2060, with a 1.3-fold higher rate of women undergoing surgery in terms of absolute numbers. The highest increase identified by the model occurred in patients 75 years and older with 38,974 (95% CI 27,294 to 50,653) posterior spinal fusions in 2060, compared with 14,657 in 2019. This trend applied for both women and men, with a 246% (95% CI 138% to 355%) increase in the total number of posterior spinal fusions for women 75 years and older and a 296% (95% CI 222% to 370%) increase for men 75 years and older. At the same time, posterior spinal fusions in all age groups younger than 55 years were projected to follow a constant or even negative trend up to 2060. Conclusion Our findings suggest that increasing use of posterior spinal fusion, particularly in patients 75 years and older, will challenge healthcare systems worldwide if current trends persist. This study may serve as a model for many other industrialized countries facing similar demographic and procedure-specific developments in the future. This emphasizes the need to focus on frailty research as well as appropriate financial and human resource management. Effective perioperative medical management, multidisciplinary treatment, and interinstitutional protocols are warranted, especially in older patients as we attempt to manage these trends in the future. Level of Evidence Level III, economic and decision analysis.

The Impostor Phenomenon can be described as the tendency to attribute professional success not to one's own abilities but to excessive effort or fortunate external circumstances. Individuals strongly experiencing those tendencies fear that one day they will be exposed as "impostors" as soon as their alleged incompetence can no longer be concealed. Typical characteristics of the Impostor Phenomenon outlined by Clance (1985) show a remarkable conceptual similarity to the personality construct of perfectionism. Thus, the present study aimed at investigating how the Impostor Phenomenon is related to various facets of dispositional perfectionism with respect to predominant conceptualizations of perfectionism by Frost et al. (1990), Hewitt and Flett (1991), as well as their combination within the bifactor model of Perfectionistic Strivings and Perfectionistic Concerns (Frost et al. 1993). A total of N = 274 individuals participated in an online survey including the Impostor Phenomenon Scale (CIPS; Clance 1988), the Frost Multidimensional Perfectionism Scale (FMPS; Frost et al. 1990), and the Hewitt und Flett Multidimensional Perfectionism Scale (MPS short form; Hewitt et al. 2008). Hierarchical regression analyses were conducted to determine the differential contributions of perfectionism dimensions and factors in predicting the Impostor Phenomenon. The perfectionism dimensions Doubts about Actions, Concern over Mistakes and Socially prescribed Perfectionism appeared to be efficient predictors of the Impostor Phenomenon. Contrary to Perfectionistic Strivings, Perfectionistic Concerns as a maladaptive perfectionism factor strongly contributed to the prediction of the Impostor Phenomenon. Theoretical and practical implications of the associations between the Impostor Phenomenon and multidimensional perfectionism are discussed.

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