The United States has the greatest number of spinal surgeries performed per year even when compared to other countries with the same amount of people with spinal stenosis. Because of the high cost, need for more surgeries and complications associated with fusions, authors of a recent study recommend a decompression surgery to address spinal stenosis. If a fusion is required, they suggest that a noninstrumented fusion is performed.
Spinal stenosis is a narrowing of the space surrounding the spinal cord. It naturally occurs as we age, however it can become bothersome if the narrowing starts to pinch on nerves that exit the spine. Often it can be managed with changing movement patterns, but sometimes surgery is warranted. While there are several options for surgery, the optimal technique is still being determined. A decompression surgery removes bone that is encroaching on these nerves and is named for the piece of bone that is removed. For example, a laminectomy removes a piece of vertebrae adjacent to the spinous process (or pokey part of your back). A fusion is another type of surgery in which hardware or bony tissue is placed to prevent the spine from moving and encroaching on nerves. An instrumented fusion utilizes actual metal hardware, like screws and rods, to stabilize the spine. A non-instrumented fusion relies on bone tissue harvested from elsewhere in the body, which is then transplanted to stabilize the spine. Sometimes surgical treatment includes a combination of the two and both a fusion and decompression surgery are performed.
Authors of this study tapped into a large database and analyzed patients who had treatment for spinal stenosis from 2002 to 2009. The number of people in the database with a spinal stenosis diagnosis was 12,657. Of those, 2,385 people had a decompression surgery and 620 patients had a fusion along with data that followed up longer than five years. They were interested in the surgical complications, (such as infection or failure of the surgery to provide relief) the need for another surgery, and the overall cost effectiveness of the surgery, which they gauged by looking at how many resources, like cost of initial surgery, emergency room visits and medication charges, occurred after the surgery.
The study found that surgical complications were significantly higher for patients who had both a laminectomy and a fusion than for patients who just had a laminectomy immediately after surgery and at a 90-day check up. Both of these patient populations however did not have a difference in the re-surgery rate, even five years after the first surgery. Authors also discovered that by the five-year mark the total costs of treatment were similar between the patients who had decompression surgery and those who had a fusion. The two types of fusions (instrumented and noninstrumented) cost-wise had a slight difference (~$7,000) with noninstrumented fusion being the cheaper of the two at around $100,471 in total care cost at a five year follow up.