Cost-utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis

2012 ◽  
Vol 12 (1) ◽  
pp. 44-54 ◽  
Author(s):  
Salin Kim ◽  
Soroush Mortaz Hedjri ◽  
Peter C. Coyte ◽  
Y. Raja Rampersaud
Keyword(s):  
Cost Utility ◽  
Lumbar Decompression ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

scholarly journals Lifetime incremental cost–utility ratios for minimally invasive surgery for degenerative lumbar spondylolisthesis relative to failed medical management compared with total hip and knee arthroplasty for osteoarthritis

2021 ◽  
Vol 64 (4) ◽  
pp. E391-E402
Author(s):  
Eric J. Crawford ◽  
Robert A. Ravinsky ◽  
Peter C. Coyte ◽  
Y. Raja Rampersaud
Keyword(s):  
Minimally Invasive Surgery ◽  
Total Joint Replacement ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Knee Oa ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Hip And Knee Arthroplasty ◽  
Lumbar Spondylolisthesis ◽  
The Cost

Background: The objective of this study was to compare the cost-effectiveness of minimally invasive surgery (MIS) for patients with degenerative lumbar spondylolisthesis (DLS) relative to failed medical management with the cost-effectiveness of hip and knee arthroplasty for matched cohorts of patients with osteoarthritis. Methods: A cohort of patients with DLS undergoing MIS procedures with decompression alone or decompression and instrumented fusion between 2008 and 2014 was matched to cohorts of patients with hip osteoarthritis (OA) and knee OA undergoing total joint replacement. Incremental cost–utility ratios (ICURs) were calculated from the perspective of the Ontario Ministry of Health, using prospectively collected Short Form–6 Dimension utility data. Costs and quality-adjusted life years (QALYs) were discounted at 3% and sensitivity analyses were performed. Results: Sixty-six patients met the inclusion criteria for the DLS cohort (n = 35 for decompression alone), with a minimum follow-up time of 1 year (mean 1.7 yr). The mean age of patients in the DLS cohort was 64.76 years, and 45 patients (68.2%) were female. For each cohort, utility scores improved from baseline to follow-up and the magnitude of the gain did not differ by group. Lifetime ICURs comparing surgical with nonsurgical care were Can$7946/QALY, Can$7104/QALY and Can$5098/QALY for the DLS, knee OA and hip OA cohorts, respectively. Subgroup analysis yielded an increased ICUR for the patients with DLS who underwent decompression and fusion (Can$9870/QALY) compared with that for the patients with DLS who underwent decompression alone (Can$5045/QALY). The rank order of the ICURs by group did not change with deterministic or probabilistic sensitivity analyses. Conclusion: Lifetime ICURs for MIS procedures for DLS are similar to those for total joint replacement. Future research should adopt a societal perspective and potentially capture further economic benefits of MIS procedures.

Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis?

2021 ◽  
pp. 1-8
Author(s):  
Andrew K. Chan ◽  
Praveen V. Mummaneni ◽  
John F. Burke ◽  
Rory R. Mayer ◽  
Erica F. Bisson ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Rating Scale ◽  
Lumbar Fusion ◽  
Radiographic Appearance ◽  
Lumbar Decompression ◽  
Significant Difference ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
The Impact

OBJECTIVE Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors’ aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis. METHODS The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)–back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction. RESULTS Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to −2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts. CONCLUSIONS Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.

scholarly journals Lumbar Decompression and Interbody Fusion Improves Gait Performance, Pain, and Psychosocial Factors of Patients With Degenerative Lumbar Spondylolisthesis

2020 ◽  
pp. 219256822091104
Author(s):  
Ram Haddas ◽  
Cezar D. Sandu ◽  
Damon Mar ◽  
Andrew Block ◽  
Isador Lieberman
Keyword(s):  
Gait Analysis ◽  
Range Of Motion ◽  
Psychosocial Factors ◽  
Surgical Intervention ◽  
Lumbar Decompression ◽  
Pain Disability ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Clinical Gait Analysis

Study Design: Prospective cohort study. Objective: Evaluate changes in gait, pain, and psychosocial factors among degenerative lumbar spondylolisthesis (DLS) patients before and 3 months after surgical intervention. Methods: Forty-four symptomatic DLS patients performed clinical gait analysis 1 week before surgery and 3 months after surgery. Patients performed a series of over-ground gait trials at a self-selected speed. Twenty-two matched asymptomatic controls underwent the same battery of tests. Three-dimensional motion tracking was used to analyze gait kinematics. Patient-reported outcomes, gait range of motion, and spatiotemporal parameters compared before and after lumbar decompression with fusion. Results: Surgical intervention resulted in significant improvements in walking speed ( P = .021), stride time ( P = .020), step time ( P = .014), and single-support time ( P = .038). Significant improvements in joint range-of-motion were found for knee ( P = .002) and hip flexion ( P = .006). Degenerative lumbar spondylolisthesis patients reported significant reductions in pain, disability, and improved psychological perceptions for fear-avoidance of pain and motion (all P < .001). Conclusions: Surgical treatment of DLS resulted in a faster, more efficient gait in addition to significant reductions in pain, disability, and psychological fear associated with pain and motion. These beneficial changes that we identified early in the postoperative period indicate that patients return to the quality of life they seek early on. Clinical gait analysis provides objective, quantifiable measures of gait parameters that provide new insight into both the preoperative disability associated with DLS and into the early postoperative function of patients during their rehabilitation.

scholarly journals Association of Lumbar Paraspinal Muscle Morphometry with Degenerative Spondylolisthesis

2021 ◽  
Vol 18 (8) ◽  
pp. 4037
Author(s):  
Eun Taek Lee ◽  
Seung Ah Lee ◽  
Yunsoo Soh ◽  
Myung Chul Yoo ◽  
Jun Ho Lee ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Protective Factor ◽  
Degenerative Spondylolisthesis ◽  
Fatty Degeneration ◽  
Erector Spinae ◽  
Cross Sectional ◽  
Skeletal Muscle Index ◽  
Fat Infiltration ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

The objective of this study was to assess the cross-sectional areas (CSA) of lumbar paraspinal muscles and their fatty degeneration in adults with degenerative lumbar spondylolisthesis (DLS) diagnosed with chronic radiculopathy, compare them with those of the same age- and sex-related groups with radiculopathy, and evaluate their correlations and the changes observed on magnetic resonance imaging (MRI). This retrospective study included 62 female patients aged 65–85 years, who were diagnosed with lumbar polyradiculopathy. The patients were divided into two groups: 30 patients with spondylolisthesis and 32 patients without spondylolisthesis. We calculated the CSA and fatty degeneration of the erector spinae (ES) and multifidus (MF) on axial T2-weighted magnetic resonance (MR) images from the inferior end plate of the L4 vertebral body levels. The functional CSA (FCSA): CSA ratio, skeletal muscle index (SMI), and MF CSA: ES CSA ratio were calculated and compared between the two groups using an independent t-test. We performed logistic regression analysis using spondylolisthesis as the dependent variable and SMI, FCSA, rFCSA, fat infiltration rate as independent variables. The result showed more fat infiltration of MF in patients with DLS (56.33 vs. 44.66%; p = 0.001). The mean FCSA (783.33 vs. 666.22 mm2; p = 0.028) of ES muscle was a statistically larger in the patients with DLS. The ES FCSA / total CSA was an independent predictor of lumbar spondylolisthesis (odd ratio =1.092, p = 0.016), while the MF FCSA / total CSA was an independent protective factor (odd ratio =0.898, p = 0.002)

P68. Mid-Term Clinical Outcome of Posterior Decompression Without Fusion for Degenerative Lumbar Spondylolisthesis

2006 ◽  
Vol 6 (5) ◽  
pp. 116S
Author(s):  
Keigo Yasui ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Jun-Ichiro Okumura ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Posterior Decompression ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

scholarly journals Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Comparative Study of 5-Year Outcomes Following Decompression with Fusion and Microendoscopic Decompression

2018 ◽  
Vol 12 (1) ◽  
pp. 132-139 ◽  
Author(s):  
Takato Aihara ◽  
Tomoaki Toyone ◽  
Yasuaki Murata ◽  
Kazuhide Inage ◽  
Makoto Urushibara ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Large Percentage ◽  
Neutral Position ◽  
Maximal Extension ◽  
Surgical Methods ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Functional Scores ◽  
Lumbar Spondylolisthesis

<sec><title>Study Design</title><p>Retrospective review of prospectively collected outcome data.</p></sec><sec><title>Purpose</title><p>To compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition.</p></sec><sec><title>Overview of Literature</title><p>There have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS.</p></sec><sec><title>Methods</title><p>Forty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.</p></sec><sec><title>Results</title><p>The degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups.</p></sec><sec><title>Conclusions</title><p>MED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.</p></sec>

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