Decompression for stenosis less costly than fusion, especially when instrumented

Study finds higher operative costs, longer hospital stays with decompression and instrumented fusion.

Issue: September 2009

A study of three common interventions for lumbar central spinal stenosis yielded cost-effectiveness results that were different enough to cause Swedish investigators to encourage others to reconsider their use of fusion techniques, particularly ones involving instrumentation.

“The costs were almost three-times higher for the instrumented fusion than for the decompression only,” said Tommy Hansson, MD, of Sweden.

These findings, which he presented at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine, were based on results of more than 400 patients with lumbar central spinal stenosis (CSS) who were treated with either decompression alone (272 patients), decompression and posterior noninstrumented fusion (41 patients) or decompression and posterior instrumented fusion (102 patients).

“If you go through the literature, there is no evidence of the difference in effectiveness between these three procedures,” Hansson noted.

Databases reviewed

Hansson and a colleague analyzed data from their hospital’s administrative and economic databases for CSS cases completed between November 2002 and November 2008. They sought to identify differences in costs and complications for patients in the three treatment groups by analyzing surgeon, operative, implant, postoperative, hospital and total costs per patient.

They found the ages of all patients were similar. More women than men underwent instrumented fusion. The amount of degenerative preoperative slip was less than 10%, which was about the same in the decompression and the instrumented fusion groups based on a radiologist’s assessment, he said.

Costs, trends

Compared to the total costs for a decompression alone, the total costs were 3.4 times higher in the instrumented fusion group and 1.3 times higher in the noninstrumented fusion group, study investigators found.

They also identified two others trends: Operative times in the instrumented fusion group were about twice as long as the decompression-only group; and instrumented fusions were associated with hospital stays that were about 30% longer than in those CSS cases treated by surgical decompression alone.

The study abstract included data on some complications associated with the cases the investigators evaluated, such as 2.8 times more bleeding with instrumented fusion and 1.7 times more bleeding with noninstrumented fusion compared to the decompression procedures.

For more information:

Tommy Hansson, MD, can be reached at Sahlgrenska Academy, University of Gothenburg, PO Box 100, SE-405 30 Gothenburg, Sweden; 46-31-342-3406; e-mail: tommy.hansson@orthop.gu.se. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

Hansson T, Johansson C. The cost-effectiveness of the three major surgical procedures in central spinal stenosis. Paper #50. Presented at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine. May 4-8, 2009. Miami.