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Surgery for Spinal Stenosis: Long-Term Reoperation Rates, Health Care Cost, and Impact of Instrumentation

Lad, Shivanand P. MD, PhD*; Babu, Ranjith MS*; Ugiliweneza, Beatrice PhD, MSPH; Patil, Chirag G. MD; Boakye, Maxwell MD

doi: 10.1097/BRS.0000000000000314
Surgery
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Study Design. Retrospective cohort analysis.

Objective. To examine the complications, reoperation rates, and resource use after each of the surgical approaches for the treatment of spinal stenosis.

Summary of Background Data. There are no uniform guidelines for which procedure (decompression, decompression with instrumentation, or decompression with noninstrumented fusion) to perform for the treatment of spinal stenosis. With no clear evidence for increased efficacy, the rate of instrumented fusions is rising.

Methods. We performed a retrospective cohort analysis of patients who underwent spinal stenosis surgery between 2002 and 2009 in the United States. Patients included (n = 12,657) were diagnosed with spinal stenosis without concurrent spondylolisthesis and had at least 2 years of preoperative enrollment. A total of 2385 patients with decompression only and 620 patients with fusion had follow-up data for 5 years or more.

Results. Complication rates during the initial procedure hospitalization and at 90 days were significantly higher for those who underwent laminectomy with fusion than for those who underwent laminectomy alone, with reoperation rates not differing significantly between these groups. Long-term (≥5 yr) reoperation rates were similar for those undergoing decompression alone versus decompression with fusion (17.3% vs. 16.0%, P = 0.44). Those with instrumented fusions had a slightly higher rate of reoperation than patients with noninstrumented fusions (17.4% vs. 12.2%, P = 0.11) at more than 5 years. The total cost including initial procedure and hospital, outpatient, emergency department, and medication charges at 5 years was similar for those who received decompression alone and fusion. The long-term costs for instrumented and noninstrumented fusions were also similar, totaling $107,056 and $100,471, respectively.

Conclusion. For patients with spinal stenosis, if fusion is warranted, use of arthrodesis without instrumentation is associated with decreased costs with similar long-term complication and reoperation rates.

Level of Evidence: 3

We examined the complications, reoperation rates, and resource use after each of the surgical approaches for spinal stenosis. Those who underwent laminectomy with fusion had a similar reoperation rate to those having laminectomy alone. Instrumented fusions also had similar reoperation rates and health care costs to noninstrumented fusions.

*Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC

Department of Neurosurgery, University of Louisville, Louisville, KY; and

Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Address correspondence and reprint requests to Shivanand P. Lad, MD, PhD, Division of Neurosurgery/Department of Surgery, Duke University Medical Center, Box 3807, Durham, NC 27710; E-mail: nandan.lad@duke.edu

Acknowledgment date: July 22, 2012. Revision date: January 23, 2014. Acceptance date: February 26, 2014.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins