Interspinous distractor device yielded higher cost, lower quality of life vs laminectomy
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Published results showed use of an interspinous distractor device for lumbar spinal stenosis yielded higher cost and lower improvement in quality of life at 24 months postoperatively compared with laminectomy.
Anouk Borg, MD, FRCS(SN), and colleagues randomly assigned 47 patients with lumbar spinal stenosis to undergo either insertion of the X-Stop Interspinous Process Decompression System (n=21; Medtronic Spine LLC) or laminectomy (n=26). Researchers included monetary cost and quality of life measured by the EuroQol-5D questionnaire at 6, 12 and 24 months.
When compared with preoperative baseline, results showed an overall improvement in mean quality of life at 6 months for both groups; however, improvements only remained significant for the laminectomy group at 12 and 24 months. Mean cost for the laminectomy group was $3,316 vs. $6,295 for the X-Stop group. Intention-to-treat analysis showed the laminectomy group had a mean quality-adjusted life-year gain of 0.92 compared with 0.81 in the X-Stop group. Researchers noted an incremental cost-effectiveness ratio of –$27,078. Patients in the X-Stop group had a 19% revision rate, and five patients from the X-Stop group crossed over to the laminectomy group, according to results.
“Both open laminectomy and insertion of the X-Stop device result in an improvement in the quality of life of patients with lumbar spinal stenosis. However, the improvement with a laminectomy is sustained for longer and the procedure is more cost-effective in the U.K. setting. This is important for health care systems where cost is a consideration as results suggest that first choice treatment should generally be lumbar laminectomy,” Borg told Healio Orthopedics. “The results demonstrate that laminectomy is a more cost-effective option for treating lumbar spinal stenosis. However, if device costs can be mitigated or if open laminectomy cannot be tolerated, there may still remain a role for interspinous distraction devices in select patients.”
Perspective
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The X-Stop interspinous distraction device is a less invasive surgical intervention for the treatment of lumbar spinal stenosis. Its safety and efficacy have been demonstrated in an FDA trial.
This prospective trial out of the U.K. demonstrates that the device is effective in treating patients with lumbar spinal stenosis. Patients were randomly assigned to laminectomy or X-Stop from 2010 to 2014 and followed for 2 years. Primarily due to the cost of the device, the X-Stop interspinous distraction device had a higher cost and lower improvement in quality of life measures when compared to the laminectomy. This is despite the fact that there were a small number of dural tears in the laminectomy cohort, but the reoperation rate was higher for the interspinous distraction device. These findings regarding cost are similar to other retrospective studies.
This study brings to our attention the need to carefully consider the utility of adding an implant cost, such as an interspinous distraction device, to a procedure such as a laminectomy. The additional cost may be more appropriate for a patient who would benefit from a less invasive procedure with lower risks of intraoperative complications.
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