For the past few decades different surgical techniques including spinal
decompression and spinal fusion have been used to successfully treat lumbar
spine conditions. Typically benefits of these surgeries are measured in pain
relief, low rate of complications and return of function. But there is new
emphasis placed on quantifying the value of surgery in terms of cost to
patients and society. Unfortunately, as recent systematic review
demonstrated, there is limited evidence available in examining cost-
effectiveness.
Lumbar stenosis (narrowing of the spinal canal) and
spondylolisthesis (forward displacement of a vertebra) are two common degenerative spine conditions. In addition to non-operative strategies, surgical decompression and arthrodesis (fusion) are accepted options for these conditions. The aforementioned systemic review was performed to examine the cost-effectiveness of these procedures. The review ran into
several limitations including scarce literature available, the inconsistency
and variability present in what literature was present and that many of the data was based on mathematical modeling algorithms versus actual patient data.
In terms of operative treatment versus non-operative treatment, it is expected that surgical techniques will have a higher upfront cost secondary to the possible hospitalization, anesthesia and invasive nature of the procedure itself. Some may argue that if there is permanent removal of the neural compression through a surgical technique the upfront costs should
dissipate over time by allowing the patient prolonged relief of symptoms and return of function and contribution to society. At this time, due to the
limited amounts of literature, there are too many limitations to support this argument one way or the other. The systemic review brought up the concept of delayed gratification being very important to analyze in a procedure that may have a prolonged course of action. There are differing opinions on when in the process this analysis should be made. A two-year time window was used by several of the studies used in the review but it was stated that this may not be a long enough period to see an effect thus reinforces the difficulty in drawing definitive conclusions on the cost-effectiveness of surgical
techniques versus non-operative treatment.