Decompression With or Without Fusion for Lumbar Stenosis: A Cost Minimization Analysis

Area of Science:

• Spinal surgery
• Health economics
• Cost-minimization analysis

Background:

• Lumbar stenosis is a leading cause of surgery in patients over 65.
• Medicare costs for lumbar surgery exceeded $1.65 billion in 2007.
• Surgical treatment for lumbar stenosis lacks a universally agreed-upon standard, prompting cost-effectiveness research.

Purpose of the Study:

• To compare the 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis.
• To perform a cost-minimization analysis from a payer perspective.

Main Methods:

• Retrospective review of an administrative claims database of privately insured patients.
• Identified patients who underwent decompression (n=5349) or decompression with fusion (n=8540) for lumbar stenosis.
• Compared overall costs for a 1-year period post-surgery, including complication-related expenses.

Main Results:

• Mean 1-year costs were substantially higher for decompression with fusion ($20,892) compared to decompression alone ($6329) (P < 0.001).
• Higher costs in the fusion group were observed for facility, surgeon, and physical therapy services (P < 0.001).
• Significant cost differences were noted for complications such as infection or durotomy (P < 0.04).

Conclusions:

• Decompression alone is a significantly lower-cost surgical option for lumbar stenosis, even when accounting for postoperative complications.
• When cost minimization is the primary objective, decompression is the favored surgical approach for lumbar stenosis.
• Patient values, reported outcomes, and preferences should also guide surgical decisions alongside cost considerations.