Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years
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Updated: Jun 27, 2026
Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis
Published on: February 9, 2024
Anna N A Tosteson1, Jon D Lurie, Tor D Tosteson
1Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Hanover, New Hampshire 03756, USA.
Background:
The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain.
Objective:
To assess the short-term cost-effectiveness of spine surgery relative to nonoperative care for stenosis alone and for stenosis with spondylolisthesis.
Design:
Prospective cohort study.
Data Sources:
Resource utilization, productivity, and EuroQol EQ-5D score measured at 6 weeks and at 3, 6, 12, and 24 months after treatment among SPORT participants.
Target Population:
Patients with image-confirmed spinal stenosis, with and without degenerative spondylolisthesis.
Time Horizon:
2 years.
Perspective:
Societal.
Intervention:
Nonoperative care or surgery (primarily decompressive laminectomy for stenosis and decompressive laminectomy with fusion for stenosis associated with degenerative spondylolisthesis).
Outcome Measures:
Cost per quality-adjusted life-year (QALY) gained.
Results Of Base-Case Analysis:
Among 634 patients with stenosis, 394 (62%) had surgery, most often decompressive laminectomy (320 of 394 [81%]). Stenosis surgeries improved health to a greater extent than nonoperative care (QALY gain, 0.17 [95% CI, 0.12 to 0.22]) at a cost of $77,600 (CI, $49,600 to $120,000) per QALY gained. Among 601 patients with degenerative spondylolisthesis, 368 (61%) had surgery, most including fusion (344 of 368 [93%]) and most with instrumentation (269 of 344 [78%]). Degenerative spondylolisthesis surgeries significantly improved health versus nonoperative care (QALY gain, 0.23 [CI, 0.19 to 0.27]), at a cost of $115,600 (CI, $90,800 to $144,900) per QALY gained. RESULT OF SENSITIVITY ANALYSIS: Surgery cost markedly affected the value of surgery.
Limitation:
The study used self-reported utilization data, 2-year time horizon, and as-treated analysis to address treatment nonadherence among randomly assigned participants.
Conclusion:
The economic value of spinal stenosis surgery at 2 years compares favorably with many health interventions. Degenerative spondylolisthesis surgery is not highly cost-effective over 2 years but could show value over a longer time horizon.
