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Spine J. 2014 Aug 1;14(8):1484-92. doi: 10.1016/j.spinee.2013.08.053. Epub 2013 Oct 4.

Interspinous device versus laminectomy for lumbar spinal stenosis: a comparative effectiveness study.

Author information

1
Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA. Electronic address: chirag.patil@cshs.org.
2
Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
3
Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA.
4
Division of Neurosurgery, Department of Surgery, Duke University Medical Center, 200 Trent Drive, Blue Zone- Room 4529, Durham, NC 27710, USA.
5
Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA; Roblex Rex VA Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA.

Abstract

BACKGROUND CONTEXT:

Currently no studies directly compare effectiveness between interspinous devices (IDs) and laminectomy in lumbar spinal stenosis (LSS) patients.

PURPOSE:

To compare reoperations, complications, and costs between LSS patients undergoing ID placement versus laminectomy.

STUDY DESIGN:

Retrospective comparative study.

PATIENT SAMPLE:

The MarketScan database (2007-2009) was queried for adults with LSS undergoing ID placement as a primary inpatient procedure.

OUTCOME MEASURES:

Reoperation rates, complication rates, and costs.

METHODS:

Each ID patient was matched with a laminectomy patient using propensity score matching. Reoperations, complications, and costs were analyzed in patients with at least 18 months postoperative follow-up. The authors did not receive funding from any external sources for this study.

RESULTS:

Among 498 inpatients that underwent ID placement between 2007 and 2009; the average age was 73 years. The cumulative reoperation rates after ID at 12 and 18 months were 21% and 23%, respectively. The average inpatient hospitalization lasted 1.6 days with an associated cost of $17,432. Two propensity-matched cohorts of 174 patients that had undergone ID versus laminectomy were analyzed. Longer length of stay was observed in the laminectomy cohort (2.5 days vs. 1.6 days, p<.0001), whereas ID patients accrued higher costs at index hospitalization ($17,674 vs. $12,670, p=.0001). Index hospitalization (7.5% vs. 3.5%, p=.099) and 90-day (9.2% vs. 3.5%, p=.028) complications were higher in the laminectomy cohort compared with the ID cohort. The ID patients had significantly higher reoperation rates than laminectomy patients at 12 months follow-up (12.6% vs. 5.8%, p=.026) and incurred higher cumulative costs than laminectomy patients at 12 months follow-up ($39,173 vs. $34,324, p=.289).

CONCLUSIONS:

Twelve-month reoperation rates and index hospitalization costs were significantly higher among patients who underwent ID compared with laminectomy for LSS.

KEYWORDS:

Decompressive surgery; Interspinous device; Laminectomy; Lumbar spinal stenosis; Neurogenic claudication; Reoperation

PMID:
24291409
DOI:
10.1016/j.spinee.2013.08.053
[Indexed for MEDLINE]

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