Surgery for spinal stenosis: long-term reoperation rates, health care cost, and impact of instrumentation.

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Purpose of Study
Study Review

There has been a significant increase in the rates of spinal fusion in the past 15 years in the United States. This study attempted to identify the efficacy and costs associated with this trend.

This study by Lad et al provided a retrospective cohort analysis of a population that underwent spinal stenosis surgery between 2002 and 2009. Financial Charges and re-operation rate information was obtained by reviewing data from Medicare, Medicaid, and commercial insurance entities.  Clinical outcomes, clinical indications, and the specifics of the type of surgery were not determined.   To give the information more meaning, the conclusions were based on a patient population that had a minimum of 2 years of pre-operative data  and 5 years of post-operative data.

Rates of reoperations based on type of surgery were derived by reviewing the CPT charges.  Information charts provided in the study include information on inpatient hospital charges, emergency room visit charges after surgery, medication charges after surgery, and other post-surgery outpatient charges.

The authors used a Propensity Score Matching technique to compare similar patient data sets for each patient group. Analysis of the Propensity Matched group analysis indicated a trending toward more complications in the instrumented fusion vs the non-instrumented fusion group, although the analysis was not statistically significant.

In summary, the study concluded that lumbar decompression without fusion may be equally efficacious to decompression and lumbar spinal fusion in the spinal stenosis population. The authors compiled meaningful charts comparing the charges associated with care between the laminectomy only patients with the laminectomy with fusion patients.  The authors also provided charge information for the instrumented vs. non instrumented spinal fusion patients.

As a comment, the original question was to identify the complication rates, re-operation rates and charge information for the various surgical options for patients who had spinal surgery for spinal stenosis.  Without the clinical data, efficacy cannot be adequately evaluated by the nature of this study.

Still, this study provided useful compilation of medical charges related to spinal surgery for lumbar stenosis.  This information along with the results from other economic impact of spine surgery studies helps the medical community understand the potential societal costs for the management of spine problems.

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