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Interspinous device versus laminectomy for lumbar spinal stenosis: a comparative effectiveness study.
Chirag G Patil1, J Manuel Sarmiento1, Beatrice Ugiliweneza2
1Department 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.
Interspinous devices (IDs) showed higher reoperation rates and initial hospitalization costs compared to laminectomy for lumbar spinal stenosis (LSS). Laminectomy had higher 90-day complication rates, but ID patients faced more reoperations within 12 months.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Lumbar spinal stenosis (LSS) treatment often involves surgical intervention.
- Interspinous devices (IDs) and laminectomy are surgical options for LSS.
- Direct comparative effectiveness studies between IDs and laminectomy for LSS are lacking.
Purpose of the Study:
- To compare reoperation rates, complication rates, and costs between LSS patients treated with interspinous devices (IDs) versus laminectomy.
- To evaluate the long-term outcomes of ID placement and laminectomy in LSS management.
Main Methods:
- Retrospective comparative study utilizing the MarketScan database (2007-2009).
- Inclusion of adult LSS patients undergoing primary inpatient ID placement.
- Propensity score matching to create comparable cohorts of ID and laminectomy patients.
- Analysis of reoperations, complications, and costs with at least 18 months of follow-up.
Main Results:
- Interspinous device (ID) patients had higher 12-month reoperation rates (12.6% vs. 5.8%) compared to laminectomy patients.
- Laminectomy cohort experienced longer inpatient stays (2.5 vs. 1.6 days) but lower index hospitalization costs ($12,670 vs. $17,674).
- Higher 90-day complication rates were observed in the laminectomy group (9.2% vs. 3.5%).
Conclusions:
- Interspinous device (ID) placement for lumbar spinal stenosis (LSS) is associated with significantly higher 12-month reoperation rates compared to laminectomy.
- Index hospitalization costs were also higher for ID procedures.
- While laminectomy showed higher short-term complication rates, the increased reoperation rate with IDs warrants consideration in treatment decisions for LSS.
