Long-Term Costs of Maximum Nonoperative Treatments in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis that Ultimately Required Surgery

Adogwa, Owoicho; Davison, Mark A.; Vuong, Victoria D.; Khalid, Syed I.; Lilly, Daniel T.; Desai, Shyam A.; Moreno, Jessica; Cheng, Joseph; Bagley, Carlos A.

doi:10.1097/brs.0000000000002849

Cited by 18 publications

(19 citation statements)

References 14 publications

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“…Of all the patients in this study, 0.8% of patients with LSS did not respond to nonsurgical treatment, and surgical intervention was needed. Despite substantial costs, conservative treatment of lumbar spinal stenosis showed only minimal improvement in pain and functionality [5].…”

Section: Conservative Treatmentsmentioning

confidence: 99%

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Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

et al. 2019

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Objective There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure. Methods EMBASE and PubMed were searched to find studies reporting on the cost-effectiveness, safety, and performance of conservative treatment, including medicinal treatments, epidural injections, physical therapy, and alternative methods, as well as surgical treatment, including laminectomy, laminectomy with fusion, and interspinous spacer decompression. Results were supplemented with manual searches. Results Despite substantial costs, persistent conservative treatment (>12 weeks) of lumbar spinal stenosis showed only minimal improvement in pain and functionality. When conservative treatment fails, surgery is more effective than continuing conservative treatment. Lumbar laminectomy with fusion has considerably greater cost than laminectomy alone, as the length of hospital stay increases, the costs for implants are substantial, and complications increase. Although laminectomy and the Superion have comparable outcomes, the Superion implant is positioned percutaneously. This approach may minimize the direct and indirect costs of outpatient rehabilitation and absenteeism, respectively. Conclusions Superion interspinous lumbar decompression is a minimally invasive procedure for patients with lumbar spinal stenosis who have failed conservative treatment. Compared with extending conservative treatment or traditional spinal surgery, interspinous lumbar decompression reduces the direct and indirect costs associated with lumbar spinal stenosis.

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Section: Conservative Treatmentsmentioning

confidence: 99%

“…Adogwa et al [5] investigated the cost and utilization of long-term maximal nonoperative therapy over five years in patients suffering LSS. The study included 4,133 patients with lumbar stenosis or spondylolisthesis who were continuously active within the insurance system for at least five years before the lumbar operation.…”

Section: Conservative Treatmentsmentioning

confidence: 99%

Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

et al. 2019

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“…18 Management of chronic low back pain, caused by underlying conditions such as symptomatic lumbar stenosis or spondylolisthesis, often involves a trial of nonoperative therapy with a subset of patients eventually requiring operative measures. 20 Opioids are a mainstay of treatment both during conservative therapy trials as well as throughout the perioperative period. 17,21,22 Whether racial variations exist in opioid use following lumbar fusion surgery for low back pain remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis

Davison

Lilly

Desai

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To assess for racial differences in opioid utilization prior to and after lumbar fusion surgery for patients with lumbar stenosis or spondylolisthesis. Methods: Clinical records from patients with lumbar stenosis or spondylolisthesis undergoing primary <3-level lumbar fusion from 2007 to 2016 were gathered from a comprehensive insurance database. Records were queried by International Classification of Diseases diagnosis/procedure codes and insurance-specific generic drug codes. Opioid use 6 months prior, through 2 years after surgery was assessed. Multivariate regression analysis was employed to investigate independent predictors of opioid use following lumbar fusion. Results: A total of 13 257 patients underwent <3-level posterior lumbar fusion. The cohort racial distribution was as follows: 80.9% white, 7.0% black, 1.0% Hispanic, 0.2% Asian, 0.2% North American Native, 0.8% “Other,” and 9.8% “Unknown.” Overall, 57.8% patients utilized opioid medications prior to index surgery. When normalized by the number opiate users, all racial cohort saw a reduction in pills disbursed and dollars billed following surgery. Preoperatively, Hispanics had the largest average pills dispensed (222.8 pills/patient) and highest average amount billed ($74.67/patient) for opioid medications. The black cohort had the greatest proportion of patients utilizing preoperative opioids (61.8%), postoperative opioids (87.1%), and long-term opioid utilization (72.7%), defined as use >1 year after index operation. Multivariate logistic regression analysis indicated Asian patients (OR 0.422, 95% CI 0.191-0.991) were less likely to use opioids following lumbar fusion. Conclusions: Racial differences exist in perioperative opioid utilization for patients undergoing lumbar fusion surgery for spinal stenosis or spondylolisthesis. Future studies are needed corroborate our findings.

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“…[5][6][7][8] Treatment of chronic lumbar pain generally begins with a trial of nonoperative therapies such as nonsteroidal antiinflammatory drugs (NSAIDs), opioid analgesics, muscle relaxants, lumbar epidural steroid injections (LESIs), physical and/or occupational therapy (PT/OT) treatments, and chiropractor sessions. 9,10 While these conservative measures are sufficient for the majority of patients, 1 a small proportion fail maximal nonoperative therapy (MNT) and elect to undergo surgical intervention. 9,11,12 Symptomatic lumbar stenosis is the most common reason patients older than 65 years undergo spine surgery in the United States, 10,13 and the costs and resource utilization associated with prolonged courses of MNT prior to spinal operations have been shown to be considerable.…”

Section: Introductionmentioning

confidence: 99%

“…9,11,12 Symptomatic lumbar stenosis is the most common reason patients older than 65 years undergo spine surgery in the United States, 10,13 and the costs and resource utilization associated with prolonged courses of MNT prior to spinal operations have been shown to be considerable. 9,[14][15][16][17] In our current era of bundled payment strategies that continue to shift the responsibility of judicious resource management onto providers, the duration and makeup of conservative trials are being reevaluated. 9,12,14,18 Significant geographic variations have been identified in the management of chronic back pain in the United States.…”

Section: Introductionmentioning

confidence: 99%

Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis

Davison

Lilly

Moreno

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis. Methods: Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed. Results: A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) ( P < .0001), opioids ( P < .0001), muscle relaxants ( P < .0001), and lumbar steroid injections ( P < .0001) were detected. A significant difference was identified in the regional MNT failure rates ( P < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions. Conclusions: Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.

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Long-Term Costs of Maximum Nonoperative Treatments in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis that Ultimately Required Surgery

Abstract: 3.

Cited by 18 publications

References 14 publications

Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)

Racial Differences in Perioperative Opioid Utilization in Lumbar Decompression and Fusion Surgery for Symptomatic Lumbar Stenosis or Spondylolisthesis

Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis

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