Cauda Equina Syndrome: Cost Burden After Spinal Decompression.

Area of Science:

• Neurosurgery
• Health Economics

Background:

• Cauda equina syndrome (CES) is a rare but severe neurologic condition with significant patient impact.
• Effective management of CES is crucial to mitigate long-term consequences.

Purpose of the Study:

• To compare the 2-year postoperative treatment costs for patients with and without CES following posterior spinal decompression.
• To identify specific treatment categories contributing to cost differences.

Main Methods:

• An observational cohort study analyzed a commercial insurance claims database.
• Patients undergoing posterior spinal decompression for lumbar spinal stenosis, radiculopathy, or disk herniation in 2017 were included.
• Treatment costs were tracked for two years post-surgery, encompassing physical therapy, pain medication, injections, bladder/bowel management, sexual dysfunction, and psychological treatments.

Main Results:

• The study included 3,140 patients; average total treatment cost was $2,996 ± $6,368.
• Patients with CES showed significantly higher costs for physical therapy (+115%) and bladder management (+697%) in the first postoperative year.
• Overall treatment costs were significantly higher for CES patients in the first year ($3,022 vs. $1,824), but this difference diminished by the second year.

Conclusions:

• A short-term increase in treatment costs was observed in the first postoperative year for CES patients.
• Physical therapy and bladder management were the primary drivers of increased costs in CES patients.
• Overall treatment costs became similar between CES and non-CES patients by the second postoperative year.