Comparative cost effectiveness of Coflex® interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis

AbstractBackgroundThis study aimed to assess the surgical outcomes of two kinds of demineralized bone matrix (DBM) putties/local autograft composites in instrumented posterolateral lumbar fusion (PLF).MethodsTwenty-seven fusion segments of 19 patients, who underwent decompression and instrumented PLF for lumbar spinal stenosis or degenerative spondylolisthesis less than grade 1, were included in this study. The PLF mass consisted of different two kinds of DBMs (Grafton® and DBX®) and local autograft. Next, 7.5 cc of Grafton® DBM/local autograft composite was implanted on the left side, and the same amount of DBX® DBM/local autograft composite was implanted on the right side in the same patient. The PLF masses of 54 total sides (27 Grafton® sides and 27 DBX® sides) were assessed for fusion based on both flexion/extension lateral radiographs and computed tomography images at 12 and 24 months postoperatively. Clinical symptoms were also evaluated.ResultsAt 12 months postoperatively, the fusion rates for the Grafton® and DBX® sides were 59.5 and 51.9%, respectively; the difference was not statistically significant (P = 0.425). At 24 months postoperatively, the fusion rates for the Grafton® and DBX® sides increased to 70.4 and 66.7%, respectively, but the difference was still not statistically significant (P = 0.574). Diabetes mellitus, smoking, and obesity (body mass index ≥25) negatively affected the fusion rate of both the Grafton® and DBX® sides. Visual analog scores for lower back pain and leg pain and Oswestry Disability Index were significantly improved after surgery (both,P < 0.01). No deep or superficial infections occurred postoperatively. No patients underwent revision surgery due to nonunion during follow-up.ConclusionsOur results suggest that two kinds of DBMs/local autograft composites might be considered as useful bone graft substitute in instrumented posterolateral fusion for lumbar spinal stenosis or degenerative spondylolisthesis less than grade 1.

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Cost-effectiveness of the X-STOP® Interspinous Spacer for Lumbar Spinal Stenosis

Spine ◽

10.1097/brs.0b013e3181f2ed2f ◽

2011 ◽

Vol 36 (5) ◽

pp. E345-E356 ◽

Cited By ~ 17

Author(s):

Grant Skidmore ◽

Stacey J. Ackerman ◽

Christopher Bergin ◽

Dan Ross ◽

Jesse Butler ◽

...

Keyword(s):

Cost Effectiveness ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Interspinous Spacer ◽

Lumbar Spinal

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Cost-effectiveness of conservative versus surgical treatment strategies of lumbar spinal stenosis in the Swiss setting: analysis of the prospective multicenter Lumbar Stenosis Outcome Study (LSOS)

European Spine Journal ◽

10.1007/s00586-016-4937-y ◽

2016 ◽

Vol 26 (2) ◽

pp. 501-509 ◽

Cited By ~ 11

Author(s):

A. Aichmair ◽

◽

J. M. Burgstaller ◽

M. Schwenkglenks ◽

J. Steurer ◽

...

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Treatment Strategies ◽

Outcome Study ◽

Lumbar Stenosis ◽

Lumbar Spinal

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Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

Pain Medicine ◽

10.1093/pm/pnz245 ◽

2019 ◽

Vol 20 (Supplement_2) ◽

pp. S2-S8

Author(s):

Kevin Cairns ◽

Tim Deer ◽

Dawood Sayed ◽

Kim van Noort ◽

Kevin Liang

Keyword(s):

Cost Effectiveness ◽

Conservative Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Indirect Costs ◽

Invasive Procedure ◽

Direct And Indirect Costs ◽

Interspinous Spacer ◽

And Performance ◽

Lumbar Spinal

Abstract Objective There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure. Methods EMBASE and PubMed were searched to find studies reporting on the cost-effectiveness, safety, and performance of conservative treatment, including medicinal treatments, epidural injections, physical therapy, and alternative methods, as well as surgical treatment, including laminectomy, laminectomy with fusion, and interspinous spacer decompression. Results were supplemented with manual searches. Results Despite substantial costs, persistent conservative treatment (>12 weeks) of lumbar spinal stenosis showed only minimal improvement in pain and functionality. When conservative treatment fails, surgery is more effective than continuing conservative treatment. Lumbar laminectomy with fusion has considerably greater cost than laminectomy alone, as the length of hospital stay increases, the costs for implants are substantial, and complications increase. Although laminectomy and the Superion have comparable outcomes, the Superion implant is positioned percutaneously. This approach may minimize the direct and indirect costs of outpatient rehabilitation and absenteeism, respectively. Conclusions Superion interspinous lumbar decompression is a minimally invasive procedure for patients with lumbar spinal stenosis who have failed conservative treatment. Compared with extending conservative treatment or traditional spinal surgery, interspinous lumbar decompression reduces the direct and indirect costs associated with lumbar spinal stenosis.

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Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years’ follow-up

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03234-3 ◽

2019 ◽

Vol 139 (10) ◽

pp. 1361-1368

Author(s):

Annan Hu ◽

Chi Sun ◽

Yun Liang ◽

Houlei Wang ◽

Xilei Li ◽

...

Keyword(s):

Retrospective Study ◽

Elderly Patients ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Fusion ◽

Lumbar Spinal

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Letter to the Editor concerning “Cost-effectiveness of conservative versus surgical treatment strategies of lumbar spinal stenosis in the Swiss setting: analysis of the prospective multicenter Lumbar Stenosis Outcome Study (LSOS)” by A. Aichmair et al. (Eur Spine J; 2016. doi:10.1007/s00586-016-4937-y)

European Spine Journal ◽

10.1007/s00586-017-4993-y ◽

2017 ◽

Vol 26 (4) ◽

pp. 1316-1317

Author(s):

Martín Avellanal

Keyword(s):

Cost Effectiveness ◽

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Treatment Strategies ◽

Outcome Study ◽

Lumbar Stenosis ◽

Letter To The Editor ◽

Lumbar Spinal

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Response to the Letter-to-the-Editor Regarding “The Two Year Cost Effectiveness of Three Options to Treat Lumbar Spinal Stenosis Patients”

Pain Practice ◽

10.1111/papr.12233 ◽

2014 ◽

Vol 14 (7) ◽

pp. e163-e164

Author(s):

Nagy Mekail ◽

Belinda Udeh

Keyword(s):

Cost Effectiveness ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Letter To The Editor ◽

Lumbar Spinal

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Five-Level Unilateral Laminectomy Bilateral Decompression (ULBD) by Two-Stage Unilateral Biportal Endoscopy (UBE)

10.21203/rs.3.rs-763052/v1 ◽

2021 ◽

Author(s):

Wenlong Wang ◽

Zheng Liu

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Fusion ◽

Invasive Procedure ◽

Rigid Fixation ◽

Minimally Invasive Procedure ◽

Two Stage ◽

Lumbar Spinal

Abstract Background Unilateral biportal endoscopy (UBE) is a relatively new yet common minimally invasive procedure in spine surgery, capable of achieving adequate decompression for lumbar spinal stenosis through unilateral laminectomy bilateral decompression (ULBD). Neither additional fusion nor rigid fixation is required, as UBE-ULBD rarely causes iatrogenic lumbar instability. However, to our knowledge, five-level ULBD via two-stage UBE without lumbar fusion has been yet to be reported in the treatment of multilevel lumbar spinal stenosis.Case description We present a case of an 80-year-old female patient who developed progressive paralysis of the lower extremities. Radiographic examinations showed multilevel degenerative lumbar spinal stenosis and extensive compression of the dural sac and nerve roots from L1-2 to L5-S1. The patient underwent five-level ULBD through two-stage UBE without lumbar fusion or fixation. One week after the final procedure, the patient could ambulate with walking aids and braces. Moreover, no back pain or limited lumbar motion was observed at the 6-month follow-up.Conclusions Multilevel ULBD through UBE may provide elderly patients with an alternative, minimally invasive procedure for treating spinal stenosis. This procedure could be achieved by staging surgeries. In this case, we reported complaints of little back pain, despite not needing to perform lumbar fusion or fixation.

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Lumbar spinal stenosis combined with obesity-induced idiopathic spinal epidural lipomatosis treated with posterior lumbar fusion: case report

BMC Surgery ◽

10.1186/s12893-021-01157-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao Han ◽

Derong Xu ◽

ZhiNan Ren ◽

Xin Chen ◽

Zheng Li ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Fusion ◽

Severe Case ◽

Modified Technique ◽

Spinal Epidural Lipomatosis ◽

Posterior Lumbar Fusion ◽

Epidural Lipomatosis ◽

Lumbar Spinal ◽

Spinal Epidural

Abstract Background Spinal epidural lipomatosis is a rare cause of lumbar spinal stenosis. While conservative therapy is applicable for most of cases, surgical intervention is necessary for severe ones. This is the first time we apply this modified technique to this disease. Case presentation The case is a 53-year-old man. He is 175 cm tall and weighs 102 kg (body mass index 33.3 kg/cm2), presenting with low back pain and bilateral legs pain and numbness. Radiological examination showed severe lumbar spinal stenosis resulting from adipose hyperplasia, combined with hyperosteogeny and hypertrophy of ligaments, which are common etiological factors. Posterior decompression, internal fixation and a modified articular fusion technique was performed on this patient, and regular follow-up that up o 22 months showed outstanding clinical outcomes. Conclusions A suitable style of posterior lumbar fusion should be considered to especially severe case with lumbar spinal stenosis and idiopathic spinal epidural lipomatosis.

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