Laminectomy more cost-effective than spinal fusion, according to SPORT researchers

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December 2008

Back pain costs more than $100 billion annually in the United States, but whether surgery is cost-effective depends on the type of procedure performed, according to a new report.

Researchers at Rush University Medical Center in Chicago suggested that for patients with spinal stenosis, a laminectomy (ie, the surgical removal of some soft bone and tissue) is a reasonable value. However, for patients who have spinal stenosis with associated slipped vertebrae, the benefits of spinal fusion surgery may not be enough to offset costs.

The study appears in the Dec. 16 issue of the Annals of Internal Medicine.

Rush was one of 13 sites throughout the country that followed patients in the Spine Patient Outcomes Research Trial (SPORT).

"This study is significant because it is the first to systematically track people’s health care expenditures and health outcomes," investigator Gunnar B.J. Andersson, MD, PhD, former chairman of the department of orthopedics at Rush, said in a press release. "More than 650,000 surgical procedures are performed annually for back pain in the United States, with costs exceeding $20 billion. Whether this investment provides a good value is largely unknown."

Investigators compared two conditions: spinal stenosis treated with laminectomy, and spinal stenosis with slipped vertebrae — also known as spinal stenosis with degenerative spondylolisthesis - which is most commonly treated with spine fusion surgery.

More than 3,900 patients participated in the randomized, controlled trial of surgery versus nonoperative treatment; 320 patients underwent laminectomy and 344 patients had spinal fusion.

Researchers used the Quality-Adjusted Life Year (QALY) scale to measure the benefit to patients in comparison to the direct and indirect costs of the surgical procedures over a 2-year postoperative period. The investigators calculated that treating stenosis surgery using laminectomy is $77,000 per QALY gained. In contrast, spinal fusion surgery for stenosis with slipped vertebrae costs about $115,000 per QALY gained, according to the press release.

The initial 2-year analysis indicated that decompressive surgery without fusion for spinal stenosis offers good value, while fusion surgery for spondylolisthesis offers less value for its cost than most accepted interventions, Andersson said in the press release. A definitive assessment of cost-effectiveness awaits longer-term outcome data, which will be analyzed further as the trial continues.

"With the number of spine surgery cases in the United States increasing and the rising costs of health care expenditures, it is extremely important for us to understand the economic value of common surgical procedures," Andersson said in the press release. "Cost-effectiveness is a critical component of providing patients with quality care."

He added: "With the SPORT trial, we have an innovative and collaborative multicenter study of elective orthopedic interventions. As we continue to analyze the outcomes of these procedures over the next decade, we will have more long-term results that will benefit back pain patients.

"For many patients suffering from back pain, getting rid of the pain is worth any cost," Andersson said in the press release.