Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

Parker, Scott L.; Anderson, Louise H.; Nelson, Teresa; Patel, Vikas V.

doi:10.14444/2028

Cited by 38 publications

(47 citation statements)

References 28 publications

(39 reference statements)

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“…Although patients with IPS effectively ameliorate mild to moderate symptom of LSS in midterm and with the relatively small trauma of surgery, the cost-effectiveness issue for IPS should be considered. Parker et al [ 25 ] use Markov model to evaluate three strategies of care for LSS. The study shows that CC has the lowest cost at $10,540 and the lowest quality-adjusted life year increase, while ISP and DI were nearly identical at about $13,950 and also at quality-adjusted life years.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP—a meta-analysis from five randomized controlled trial studies

Zhao

Duan²,

Gao

et al. 2018

J Orthop Surg Res

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BackgroundDecompressive laminectomy (DI) is a standard operation for lumbar spinal stenosis (LSS) patient with severe claudication symptoms for many years. However, patients whose symptom severity does not meet undergoing invasive surgery make therapeutic options into dilemma. Interspinous spacers (ISP) bridge the gap between surgical interventions and CC in management of LSS. In our study, we aim to systematically assess the two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP.MethodsElectronic databases, including PubMed, Embase, MEDLINE, Cochrane Library were searched to retrieve clinical trials concerning the comparison between Superion and X-STOP in treatment for lumbar spinal stenosis before April 2017. The following outcome measures were extracted: (1) Zurich Claudication Questionnaire (ZCQ) patient satisfaction score, (2) axial pain severity, (3) extremity pain severity, (4) back-specific functional impairment, (5) reoperation, and (6) complication. The data analysis was conducted with Review Manager 5.3.ResultsFive randomized controlled trials (RCTs) with 1118 patients were included in this meta-analysis. The pooled analysis indicated that the Superion group is superior to X-STOP in axial pain severity (SMD: 0.03; 95% CI 0.15, 0.45; p < 0.0001, I2 = 41%, p = 0.16), ZCQ patient satisfaction score (SMD: 0.23; 95% CI 0.08, 0.38; p = 0.002, I2 = 0%, p = 0.61). However, Superion group showed similarity outcome in extremity pain severity (SMD: 0.18; 95% CI − 0.06, 0.43; p = 0.14, I2 = 62%, p = 0.05), back-specific functional impairment (SMD: 0.04; 95% CI − 0.10, 0.19; p = 0.56, I2 = 0%, p = 0.77), reoperation rate (RR: 1.10; 95% CI 0.82, 1.48; p = 0.51, I2 = 19%, p = 0.30), and complication (RR: 0.98; 95% CI 0.63, 1.53; p = 0.92, I2 = 0%, p = 0.83).ConclusionBoth the Superion and X-STOP interspinous spacers can relieve symptoms of LSS. In addition, the Superion spacer may represent a promising spacer for patient with LSS. As we know, the effectiveness and safety of ISP is still considered investigational and unfavor clinical results in the medical literature may continue to limit the appeal of IPS to many surgeons in the future. However, because of the advantage of IPS technique, it will win a wide place in the future degenerative lumbar microsurgery.

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Section: Discussionmentioning

confidence: 99%

RETRACTED ARTICLE: Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP—a meta-analysis from five randomized controlled trial studies

Zhao

Duan²,

Gao

et al. 2018

J Orthop Surg Res

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“…The cost associated with ISS is comparable to that of traditional surgery ($13,950); however, when one considers the percutaneous approach of spacers vs. an open decompressive laminectomy, the minimally invasive nature of the former is understandably more attractive (to physicians and patients alike) due to the lower complication rate. Obviously, conservative care carries the lowest average cost ($10,540) and the least risk; however, evidence suggests an ISS is superior to conservative care …”

Section: Therapies To Consider For the Treatment Algorithmmentioning

confidence: 99%

“…85 Parker et al compared conservative care, ISS, and laminectomy in an effort to elucidate which was more cost effective and used quality adjusted life years (QALY). 91 A Markov model simulated cost, health outcomes, and incremental cost effectiveness of the 3 treatment modalities. Although conservative care carried the lowest overall cost, it also imparted the lowest QALY (0.06 compared to 0.26 for ISS/surgery).…”

Section: Interspinous Spacers For Indirect Lumbar Decompressionmentioning

confidence: 99%

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Deer¹,

Grider

Pope

et al. 2018

Pain Practice

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Background Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. Methods The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer‐reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. Results The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image‐guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. Conclusions MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer‐reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence‐based decision algorithm.

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“…Markov models were employed to perform the analyses in the longer-term horizons [16] [25] [50]. Three months was the most common choice of cycle length, with two models employing such a length [16] [24]. All models with time horizon over 12-months discounted appropriately, aside from one which explicitly ruled out discounting, incorrectly [23].…”

Section: Time Horizon Cycle Length and Discountingmentioning

confidence: 99%

Systematic Review of Decision Analytic Modelling in Economic Evaluations of Low Back Pain and Sciatica

Hall

Konstantinou

Lewis

et al. 2019

Appl Health Econ Health Policy

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer

Cited by 38 publications

References 28 publications

RETRACTED ARTICLE: Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP—a meta-analysis from five randomized controlled trial studies

RETRACTED ARTICLE: Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP—a meta-analysis from five randomized controlled trial studies

The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment

Systematic Review of Decision Analytic Modelling in Economic Evaluations of Low Back Pain and Sciatica

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