Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP.

Abstract

OBJECT Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. METHODS The authors performed a structured literature review of lumbar stenosis and constructed a cost-effectiveness model. Using conservative treatment, decompressive laminectomy, and placement of X-STOP as the treatment arms, their primary analysis evaluated the optimal treatment strategy for a patient with lumbar stenosis at a 2-year time horizon. Secondary analyses were done to compare cases in which patients required single-level procedures with those in which multilevel procedures were required as well as to examine the outcomes for a 4-year time horizon. Outcomes were calculated using quality-adjusted life years and costs were considered from the perspective of society. RESULTS Laminectomy was found to be the most effective treatment strategy, followed by X-STOP and then conservative treatment at a 2-year time horizon. Both surgical procedures were more costly than conservative treatment. Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP. CONCLUSIONS Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis.

• Authors: Mark G Burnett, Sherman C Stein, Ronald H M A Bartels
• Journal: Journal of neurosurgery. Spine (J Neurosurg Spine) Vol. 13 Issue 1 Pg. 39-46 (Jul 2010) ISSN: 1547-5646 [Electronic] United States
• PMID: 20594016 (Publication Type: Journal Article, Review)

Topics

• Biomechanical Phenomena
• Cost-Benefit Analysis
• Decision Trees
• Decompression, Surgical (economics, instrumentation, methods)
• Disability Evaluation
• Humans
• Laminectomy (economics, methods)
• Lumbar Vertebrae (surgery)
• Orthopedic Fixation Devices
• Quality-Adjusted Life Years
• Spinal Stenosis (economics, surgery)