Document Detail


Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the Medicare population.
MedLine Citation:
PMID:  23324936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Retrospective cohort analysis of Medicare claims for 2006-2009.
OBJECTIVE: To examine whether interspinous distraction procedures are used selectively in patients with more advanced age or comorbidity, and whether they are associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery.
SUMMARY OF BACKGROUND DATA: A manufacturer-sponsored randomized trial suggested an advantage of interspinous spacer surgery compared with nonsurgical care, but there are few comparisons with other surgical procedures. Furthermore, there are few population-based data evaluating patterns of use of these devices.
METHODS: We used Medicare inpatient claims data to compare age and comorbidity for patients with spinal stenosis undergoing surgery (n = 99,084) with (1) an interspinous process spacer alone; (2) laminectomy and a spacer; (3) decompression alone; or (4) lumbar fusion (1-2 level). We also compared these 4 groups for cost of surgery and rates of revision surgery, major medical complications, wound complications, mortality, and 30-day readmission rates.
RESULTS: Patients who received spacers were older than those undergoing decompression or fusion, but had little evidence of greater comorbidity. Patients receiving a spacer alone had fewer major medical complications than those undergoing decompression or fusion surgery (1.2% vs. 1.8% and 3.3%, respectively), but had higher rates of further inpatient lumbar surgery (16.7% vs. 8.5% for decompression and 9.8% for fusion at 2 yr). Hospital payments for spacer surgery were greater than those for decompression alone but less than for fusion procedures. These associations persisted in multivariate models adjusting for patient age, sex, comorbidity score, and previous hospitalization.
CONCLUSION: Compared with decompression or fusion, interspinous distraction procedures pose a trade-off in outcomes: fewer complications for the index operation, but higher rates of revision surgery. This information should help patients make more informed choices, but further research is needed to define optimal indications for these new devices.Level of Evidence: 4.
Authors:
Richard A Deyo; Brook I Martin; Alex Ching; Anna N A Tosteson; Jeffrey G Jarvik; William Kreuter; Sohail K Mirza
Related Documents :
11454486 - Outpatient laparoscopic cholecystectomy. a prospective study with 100 consecutive patie...
1339886 - Laparoscopic cholecystectomy: initial experience in lebanon.
17002856 - Variations in consenting practice for laparoscopic cholecystectomy.
17127186 - Gallstone disease: surgical aspects of symptomatic cholecystolithiasis and acute cholec...
14975796 - Hypothalamic hamartoma with refractory epilepsy: surgical procedures and results in 18 ...
3456716 - The effects of orthognathic surgery on speech production.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Spine     Volume:  38     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-30     Completed Date:  2013-12-04     Revised Date:  2014-05-07    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  865-72     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Chi-Square Distribution
Decompression, Surgical / methods*
Female
Humans
Logistic Models
Male
Medicare / economics,  statistics & numerical data
Patient Readmission / statistics & numerical data
Postoperative Complications / mortality
Prosthesis Implantation*
Reoperation
Retrospective Studies
Spinal Fusion / methods*
Spinal Stenosis / mortality,  surgery*
Survival Rate
United States
Grant Support
ID/Acronym/Agency:
1 UL1 RR024140-01/RR/NCRR NIH HHS; 1R01AR054912-01A2/AR/NIAMS NIH HHS; R01 AR054912/AR/NIAMS NIH HHS; R01 HS018405/HS/AHRQ HHS; R01HS018405/HS/AHRQ HHS; RC1 AG036268/AG/NIA NIH HHS; RC1AG036268/AG/NIA NIH HHS; UL1 RR024140/RR/NCRR NIH HHS; UL1 TR000423/TR/NCATS NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  The Reversibility of Swan Neck Deformity in Chronic Atlantoaxial Dislocations.
Next Document:  Bacteroides fragilis vertebral osteomyelitis complicated by percutaneous epidural adhesiolysis : a c...