Publication:


abstract

OBJECT:

Despite advances in technology and understanding in spinal physiology, reoperation for symptomatic same-level recurrent stenosis continues to occur. Although revision lumbar surgery is effective, attention has turned to the question of the utility and value of revision decompression and fusion procedures. To date, an analysis of Cost and heath state gain associated with revision lumbar surgery for recurrent same-level lumbar stenosis has yet to be described. The authors set out to assess the 2-year comprehensive cost of revision surgery and determine its value in the treatment of same-level recurrent stenosis.

METHODS:

Forty-two patients undergoing revision decompression and instrumented fusion for same-level recurrent stenosis-associated leg and back pain were included in this study. Two-year total back-related medical resource utilization, missed work, and health state values (quality-adjusted life years [QALYs], calculated from the EQ-5D with US valuation) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost), and patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Mean total 2-year cost per QALY gained after revision surgery was assessed.

RESULTS:

The mean (± SD) interval between prior and revision surgery was 4.16 ± 4.64 years. Bone morphogenetic protein was used in 7 cases of revision arthrodesis (16.7%). A mean cumulative 2-year gain of 0.84 QALY was observed after revision surgery. The mean total 2-year cost of revision fusion was $49,431 ± $7583 (surgery cost $21,060 ± $4459; outpatient resource utilization cost $9748 ± $5292; indirect cost $18,623 ± $9098). Revision decompression and extension of fusion was associated with a mean 2-year cost per QALY gained of $58,846.

CONCLUSIONS:

In the authors' practice, revision decompression and fusion provided a significant gain in health state utility for patients with symptomatic same-level recurrent stenosis, with a 2-year cost per QALY gained of $58,846. When indicated, revision surgery for same-level recurrent stenosis is a valuable treatment option for patients experiencing back and leg pain secondary to this disease. The authors' findings provide a value measure of surgery that can be compared with the results of future cost-per-QALY-gained studies of medical management or alternative surgical approaches.

Related Articles
Cost per quality-adjusted life year gained of laminectomy and extension of instrumented fusion for adjacent-segment disease: defining the value of surgical intervention.
J Neurosurg Spine. 2012
Cost per quality-adjusted life year gained of laminectomy and extension of instrumented fusion for adjacent-segment disease: defining the value of surgical intervention.
Adogwa O, Parker SL, Shau DN, Mendenhall SK, Devin CJ, Cheng JS, McGirt MJ. J Neurosurg Spine. 2012 Feb; 16(2):141-6. Epub 2011 Nov 4.
Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy.
Spine J. 2011
Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy.
Parker SL, Fulchiero EC, Davis BJ, Adogwa O, Aaronson OS, Cheng JS, Devin CJ, McGirt MJ. Spine J. 2011 Aug; 11(8):705-11. Epub 2011 Jun 8.
Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis.
J Neurosurg Spine. 2011
Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis.
Adogwa O, Parker SL, Davis BJ, Aaronson O, Devin C, Cheng JS, McGirt MJ. J Neurosurg Spine. 2011 Aug; 15(2):138-43. Epub 2011 May 6.
Review [Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence].
Neurocirugia (Astur). 2007
Review [Controversies about instrumented surgery and pain relief in degenerative lumbar spine pain. Results of scientific evidence].
Robaina-Padrón FJ. Neurocirugia (Astur). 2007 Oct; 18(5):406-13.
Review Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP.
J Neurosurg Spine. 2010
Review Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP.
Burnett MG, Stein SC, Bartels RH. J Neurosurg Spine. 2010 Jul; 13(1):39-46.