Cost-effectiveness of lumbar discectomy and single-level fusion for spondylolisthesis: experience with the NeuroPoint-SD registry

Object There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes. Methods An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level fusion for spondylolisthesis or single-level lumbar discectomy were included. The 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: lumbar disc (125 patients) and lumbar listhesis (35 patients). The quality-adjusted life year (QALY) data were calculated using 6-dimension utility index scores. Direct costs and complication costs were estimated using Medicare reimbursement values from 2011, and indirect costs were estimated using the human capital approach with the 2011 US national wage index. Total costs equaled $14,980 for lumbar discectomy and $43,852 for surgery for lumbar spondylolisthesis. Results There were 198 patients enrolled over 1 year. The mean age was 46 years (49% female) for lumbar discectomy (n = 148) and 58.1 years (60% female) for lumbar spondylolisthesis (n = 50). Ten patients with disc herniation (6.8%) and 1 with listhesis (2%) required repeat operation at 1 year. The overall 1-year follow-up rate was 88%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, visual analog scale, and SF-36 scores (p = 0.0002), which persisted at the 1-year evaluation (p < 0.0001). By 1 year, more than 80% of patients in each cohort who were working preoperatively had returned to work. Lumbar discectomy was associated with a gain of 0.225 QALYs over the 1-year study period ($66,578/QALY gained). Lumbar spinal fusion for Grade I listhesis was associated with a gain of 0.195 QALYs over the 1-year study period ($224,420/QALY gained). Conclusions This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. These data are useful for demonstrating return to work and cost-effectiveness following surgical treatment of single-level lumbar disc herniation or spondylolisthesis. One-year cost per QALY was obtained, and this cost per QALY is expected to improve further by 2 years. This work sets the stage for real-world analysis of the value of health interventions.

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The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

Journal of Neurosurgery Spine ◽

10.3171/2013.7.spine1362 ◽

2013 ◽

Vol 19 (5) ◽

pp. 555-563 ◽

Cited By ~ 16

Author(s):

Zoher Ghogawala ◽

Christopher I. Shaffrey ◽

Anthony L. Asher ◽

Robert F. Heary ◽

Tanya Logvinenko ◽

...

Keyword(s):

Disc Herniation ◽

Patient Reported Outcome ◽

Lumbar Discectomy ◽

Cooperative Research ◽

Single Level ◽

Sf 36 ◽

Patient Reported ◽

Lumbar Spondylolisthesis ◽

Level Fusion

Object There is significant practice variation and considerable uncertainty among payers and other major stakeholders as to whether many surgical treatments are effective in actual US spine practice. The aim of this study was to establish a multicenter cooperative research group and demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures using prospectively collected patient-reported outcome measures. Methods An observational prospective cohort study was conducted at 13 US academic and community sites. Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis were included. Patients completed the 36-item Short-Form Survey Instrument (SF-36), Oswestry Disability Index (ODI), and visual analog scale (VAS) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: 125 patients with lumbar disc herniation, and 35 with lumbar spondylolisthesis. All patient data were entered into a secure Internet-based data management platform. Results Of 249 patients screened, there were 198 enrolled over 1 year. The median age of the patients was 45.0 years (49% female) for lumbar discectomy (n = 148), and 58.0 years (58% female) for lumbar spondylolisthesis (n = 50). At 30 days, 12 complications (6.1% of study population) were identified. Ten patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis required reoperation. The overall follow-up rate for the collection of patient-reported outcome data over 1 year was 88.3%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, VAS, and SF-36 scores (p ≤ 0.0002), which persisted over the 1-year follow-up period (p < 0.0001). By the 1-year follow-up evaluation, more than 80% of patients in each cohort who were working preoperatively had returned to work. Conclusions It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice. Clinical trial registration no.: 01220921 (ClinicalTrials.gov).

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Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174703 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1141

Author(s):

Prakash U. Chavan ◽

Mahendra Gudhe ◽

Ashok Munde ◽

Balaji Jadhav

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operating Time ◽

Lumbar Discectomy ◽

Leg Pain ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Single Level ◽

Group I ◽

Endoscopic Lumbar Discectomy

Background: The objective of the study was to compare surgical outcome of micro-discectomy with transforaminal percutaneous endoscopic lumbar discectomy for single level lumbar disc herniation in Indian rural population.Methods: Retrospective comparative study was designed during the period of October 2012 to June 2015, patients in the age group of 22-75 years with unremitting sciatica with/without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression as revealed on MRI, with single level lumbar disc herniation who underwent either microdiscectomy or TPELD were included in the study. Patients were assessed on visual analogue scale (VAS) for back and leg pain, modified macnabs criteria, the Oswestry Disability Index (ODI).Results: Group I (MD) included 44 patients and Group II (TPELD) included 20 patients. Significant improvement was seen in claudication symptom post-operatively in both MD and TPELD. Mean operating time was significantly shorter in MD group (1.11 hrs vs. 1.32 hrs; p<0.01). According to modified MacNab's criteria, outcome were excellent (81.8%), good (9.09%) and fair (9.09%) in MD. Similarly, in TPELD, 80%, 15% and 5% patients had excellent, good and fair outcome respectively. In both groups, no one had a poor outcome. Thus, overall success rate was 100% in the study.Conclusions: TPELD and MD have comparable post-operative outcome in most of the efficacy parameters in Indian rural patients undergoing treatment of single level lumbar disc herniation. Additionally, TPELD offers distinct advantages such as performed under local anaesthesia, preservation of structure, lesser post-operative pain and early mobilization and discharge from hospital.

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Investigation of Systemic Inflammation in Single Level Lumbar Disc Herniation and Multilevel Lumbar Spinal Stenosis Patients

Konuralp Tıp Dergisi ◽

10.18521/ktd.566585 ◽

2019 ◽

pp. 247-251

Author(s):

Ömer Polat ◽

Cengiz Tuncer

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Disc Herniation ◽

Systemic Inflammation ◽

Disc Herniation ◽

Lumbar Disc ◽

Single Level ◽

Lumbar Spinal

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Isolated Bowel and Bladder Dysfunction following Single Level Lumbar Discectomy : A Rare Observation

Bangladesh Journal of Neurosurgery ◽

10.3329/bjns.v9i1.42934 ◽

2019 ◽

Vol 9 (1) ◽

pp. 54-56

Author(s):

Moududul Haque ◽

Mohammad Sujan Sharif ◽

Nowshin Jahan ◽

Abdullah Al Mahbub ◽

Rajib Bhattacherjee

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Bladder Dysfunction ◽

Lumbar Disc ◽

Cauda Equina ◽

Lumbar Discectomy ◽

Leg Pain ◽

Imaging Studies ◽

Single Level ◽

Bowel And Bladder Dysfunction

Cauda equina syndrome is reported as a complication in 0.2% - 1% following lumbar disc herniation . The pathophysiologic mechanism of this complication and its management is yet poorly understood. Though some factors has postulated in different studies. In this case, patient’s back pain and leg pain is satisfactorily improved with newly onset retention of urine followed by overflow incontinence and constipation after a single level lumbar discectomy. No abnormalities were seen on the postoperative imaging studies. This is a retrospective analysis of records and radiographs in a patient who developed acute bowel and bladder dysfunction after surgery for lumbar disc herniation. Bang. J Neurosurgery 2019; 9(1): 54-56

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Early Outcomes: A Comparison between Biportal Endoscopic Spine Surgery and Open Lumbar Discectomy for Single-Level Lumbar Disc Herniation

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.01.11524 ◽

2021 ◽

Vol 104 (1) ◽

pp. 123-128

Keyword(s):

Postoperative Pain ◽

Lumbar Disc Herniation ◽

Spine Surgery ◽

Disc Herniation ◽

Lumbar Disc ◽

Hospital Costs ◽

Lumbar Discectomy ◽

Morphine Consumption ◽

Single Level ◽

Endoscopic Spine Surgery

Objective: To compare early outcomes between biportal endoscopic spine surgery (BESS) and open lumbar discectomy (OLD) for treating single-level lumbar disc herniation. Materials and Methods: A retrospective cohort study was conducted in 80 cases of single-level lumbar disc herniation that underwent either BESS or OLD. The author compared the perioperative data between BESS and OLD, including operative time (OT), level, side, estimated blood loss (EBL), surgical drain output, hospital stay (HS), hospital costs, visual analogue scale (VAS) scores, morphine consumption, complication, and McNab’s satisfaction outcome. Results: Forty-three patients underwent BESS and 37 underwent OLD. There was 55% female and 45% male. The mean age was 37.8±9.5 years. The BESS group showed significantly (a) lower median morphine consumption than the OLD group (five mg versus nine mg, p<0.001), (b) lower postoperative pain (VAS) at 2-, 4-, 12-, 24-, 48- (p<0.001), and 72-hours post-surgery (p=0.017), and (c) shorter HS (4.8±2.9 days versus 7.4±4.6 days, p=0.003). McNab’s satisfaction outcome of a good or excellent result was comparable between BESS and OLD group (97.7% versus 86.5%, p=0.090). The BESS group, however, had a longer OT than the OLD group (100.4±28.5 versus 67.9±23.2 minutes, p<0.001), and had a higher hospital cost (1,256±360.9 USD versus 910.6±269.8 USD, p<0.001). Complications were not significantly different between the BESS and OLD groups. Conclusion: BESS for single-level lumbar discectomy had less postoperative pain for up to 72 hours, less opioid consumption, and shorter HS, but longer OT and higher hospital costs than OLD. Patient satisfaction outcomes were comparable between the two groups. Keywords: Biportal endoscopic spine surgery, Unilateral biportal endoscopic discectomy, Open lumbar discectomy, Single-level lumbar disc herniation

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RECURRENT LUMBAR DISC HERNIATION AFTER SINGLE-LEVEL LUMBAR DISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000350224.36213.f9 ◽

2009 ◽

Vol 65 (3) ◽

pp. 574-578 ◽

Cited By ~ 104

Author(s):

Giannina L. Garcés Ambrossi ◽

Matthew J. McGirt ◽

Daniel M. Sciubba ◽

Timothy F. Witham ◽

Jean-Paul Wolinsky ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Single Level ◽

Recurrent Disc Herniation ◽

Care Costs ◽

Recurrent Lumbar Disc Herniation

Abstract OBJECTIVE Same-level recurrent lumbar disc herniation complicates outcomes after primary discectomy in a subset of patients. The health care costs associated with the management of this complication are currently unknown. We set out to identify the incidence and health care cost of same-level recurrent disc herniation after single-level lumbar discectomy at our institution. METHODS We retrospectively reviewed 156 consecutive patients undergoing primary single-level lumbar discectomy at one institution. The incidence of symptomatic same-level recurrent disc herniation either responding to conservative therapy or requiring revision discectomy was assessed. Institutional billing and accounting records were reviewed to determine the billing costs of all diagnostic and therapeutic measures used for patients experiencing recurrent disc herniation. RESULTS Twelve months after surgery, 141 patients were available for follow-up. Of these patients, 124 (88%) were symptom free or had minimal symptoms not affecting their daily activity. Radiographically proven symptomatic same-level recurrent disc herniation developed in 17 patients (12%) a median of 8 months after primary discectomy. Eleven patients (7%) required revision surgery, whereas 6 (3.9%) responded to conservative therapy alone. Diagnosis and management of recurrent disc herniation were associated with a mean cost of $26 593 per patient, and the mean cost was markedly less for patients responding to conservative treatment ($2315) compared with those requiring revision surgery ($39 836) (P < 0.001). Of 141 primary lumbar discectomies performed at our institution with the patients followed for 1 year, the total cost associated with the management of subsequent recurrent disc herniation was $452 083 ($289 797 per 100 primary discectomies). CONCLUSION In our experience, recurrent lumbar disc herniation occurred in more than 10% of patients and was associated with substantial health care costs. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the health care costs and morbidity associated with this complication. Prolonged conservative management should be attempted when possible to reduce the health care costs of this complication.

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Clinical and Functional Results of Patients with Surgically Treated Single Level Lumbar Disc Disease: Comparative Analysis of Patients with Disc Herniation, Stenosis of the Spinal Canal, and Lumbar Spondylolisthesis

Global Spine Journal ◽

10.1055/s-0035-1554540 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554540-s-0035-1554540

Author(s):

Asdrubal Falavigna ◽

Orlando Righesso ◽

Alisson Roberto Teles ◽

Pedro Guarise da Silva ◽

Lucas Piccoli Conzatti ◽

...

Keyword(s):

Comparative Analysis ◽

Disc Herniation ◽

Spinal Canal ◽

Lumbar Disc ◽

Functional Results ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Single Level ◽

Lumbar Spondylolisthesis

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EFFICACY OF ANTIBIOTICS PROPHYLAXIS IN PATIENTS WITH LUMBAR DISC HERNIATION UNDERGOING LUMBAR DISCETOMY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.5.2 ◽

2018 ◽

Vol 8 (5) ◽

pp. 14-19

Author(s):

Tri Truong Van ◽

Tri Tran Duc Duy ◽

Khai Vo Le Quang

Keyword(s):

Surgical Site Infection ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

University Hospital ◽

Site Infection ◽

Surgical Wound ◽

A Prospective Study ◽

Length Of Hospitalization

Introduction: Surgical wound infection in developing coutries is about 3%. Antibiotics prophylaxis may help to reduce the surgical site infection. The objective of this study was to evaluate the efficacy of antibiotics prophylaxis in patients with lumbar disc herniation who were treated with lumbar discectomy at Hue University hospital. Materials and Methods: A prospective study was conducted at Hue University hospital from March 2015 to May 2018 on 54 patients with lumbar disc herniation who were used antibiotics prophylaxis when undergoing discectomy. Results: The infection rate in our study was 0%. Antibiotics prophylaxis reduced the length of hospitalization as well as the medical cost. Conclusion: Antibiotics prophylaxis was effective in preventing surgical site infection despite the fact that the condition of operating rooms did not meet the standard rules. Key words: prophylaxis antibiotics, lumbar disc herniation

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