A group of researchers performed a retrospective cohort analysis of patients who underwent spinal surgery for lumbar stenosis between 2002 and 2009 in the United States to examine outcomes and costs. The research was published in Spine.
There were a total of 2,385 patients included in the study who underwent decompression only and 620 patients who underwent decompression with fusion. Every patient was followed for at least five years.
Here are five things to know about the study and treatment for lumbar spinal stenosis:
1. Complication rates during the initial procedure hospitalization and up to 90 days postoperatively were significantly higher in the patients who had laminectomy with fusion than those who underwent laminectomy alone. However, long term reoperation rates were not significantly different between the two group — 17.3 percent among the standalone group compared to 16 percent among the fusion group.
2. Patients with instrumented fusions had a slightly higher reoperation rate than patients with noninstrumented fusions at five years—17.4 percent compared with 12.2 percent. While there are no uniform guidelines for which procedure to perform in patients with spinal stenosis, the rate of instrumentation is raising and these researchers sought to examine the impact of instrumentation.
3. The total cost of care — including the procedure, hospital stay, outpatient visit, emergency department costs and medication — were similar between the two groups at five years. Among those who underwent fusions, instrumented fusions cost was $107,056 compared with noninstrumented fusion, which cost $100,471.
"For patients with spinal stenosis, if fusion is warranted, use of arthrodesis without instrumentation is associated with decreased cost and similar long-term complication and reoperation rates," concluded the study authors.
4. As the aging population increase, it's estimated that 2.4 million Americans will be affected by lumbar spinal stenosis by 2021, according to an AAOS Now report. The incidence of lumbar spinal stenosis is currently at 8 percent to 11 percent of the population. The Maine Lumbar Spine Study showed that 80 percent of patients are happy with surgical outcomes for spinal stenosis in eight years to 10 years after surgery.
5. A separate study published in 2012 examined 54 patients who underwent decompression for spinal stenosis and showed patients can achieve satisfactory results without fusion. The average operative time for patients in the study was 78 minutes and average blood loss was 37 mL per level — 77 levels were operated on. Patient satisfaction was high and pain medication for leg and back pain was low.
"Minimally invasive bilateral decompression of acquired spinal stenosis from a unilateral approach can be successfully accomplished with reasonable operative times, minimal blood loss and acceptable morbidity," concluded the study authors. "Two-year outcomes in this series revealed high patient satisfaction and only one patient progressed to lumbar fusion."
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