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Review
. 2010 Jul;13(1):39-46.
doi: 10.3171/2010.3.SPINE09552.

Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP

Affiliations
Review

Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP

Mark G Burnett et al. J Neurosurg Spine. 2010 Jul.

Abstract

OBJECT Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. METHODS The authors performed a structured literature review of lumbar stenosis and constructed a cost-effectiveness model. Using conservative treatment, decompressive laminectomy, and placement of X-STOP as the treatment arms, their primary analysis evaluated the optimal treatment strategy for a patient with lumbar stenosis at a 2-year time horizon. Secondary analyses were done to compare cases in which patients required single-level procedures with those in which multilevel procedures were required as well as to examine the outcomes for a 4-year time horizon. Outcomes were calculated using quality-adjusted life years and costs were considered from the perspective of society. RESULTS Laminectomy was found to be the most effective treatment strategy, followed by X-STOP and then conservative treatment at a 2-year time horizon. Both surgical procedures were more costly than conservative treatment. Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP. CONCLUSIONS Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis.

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Comment in

  • Treatment options for lumbar spinal stenosis.
    Fehlings MG, Chua SY. Fehlings MG, et al. J Neurosurg Spine. 2010 Jul;13(1):36-8; author reply 38. doi: 10.3171/2009.11.SPINE09853. J Neurosurg Spine. 2010. PMID: 20594015 No abstract available.
  • Spinal stenosis.
    Skidmore G, Ackerman SJ. Skidmore G, et al. J Neurosurg Spine. 2011 Jul;15(1):125-6. doi: 10.3171/2010.11.SPINE10676. Epub 2011 Apr 15. J Neurosurg Spine. 2011. PMID: 21495814 No abstract available.

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