Decompression without fusion for lumbar stenosis is cost effective

Researchers found that lumbar decompression without fusion can be just as effective in treating spinal stenosis as other methods, but has cost advantages and may result in less complications.

“As lumbar decompressions without fusion may be equally efficacious for the treatment of spinal stenosis, increased consideration should be paid to these procedures considering lower morbidity and significantly lower costs. If fusion is warranted, use of bone grafting alone may be considered instead of instrumentation in those patients with spinal stenosis without gross spinal instability, due to decreased costs with similar long-term complication and reoperation rates,” Shivanand P. Lad, MD, PhD, and colleagues wrote in the study.

They analyzed 2,385 individuals who were treated with decompression only and 620 patients treated with fusion among 12,657 patients diagnosed with spinal stenosis without concurrent spondylolisthesis who were treated between 2002 and 2009.

Lad and colleagues found complication rates rose considerably in patients who underwent laminectomy with fusion as part of their treatment at time of surgery and at 90 days postop compared with those who underwent laminectomy alone.

“The overall rate of reoperation after the initial procedure was found to be significantly lower in those who underwent a laminectomy with fusion than in those who only had a decompression at 1 year after surgery. However, this did not remain significant, with 2 year, 5 year, and long-term reoperation rates being similar between the groups,” they wrote.

Additionally, if fusion is warranted in a procedure, Lad and colleagues noted the surgeon should consider possibly using bone grafting instead of instrumentation alone since it is more cost effective yet may provide similar results.

Disclosure: The authors report no relevant financial disclosures.

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Source:

Lad SP. Spine 2014;doi:10.1097/BRS.0000000000000314