Study reports that less-invasive option for spinal stenosis poses 'trade-off' in outcomes

Published on May 8, 2013 at 6:37 AM · No Comments

Interspinous spacer implantation-a less-invasive alternative surgical option for spinal stenosis-has a lower complication rate than spinal fusion, reports a study in the May 1 issue of Spine The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

However, patients receiving interspinous spacers are more likely to require repeated back surgery, according to the report by Dr Ricard A. Deyo and colleagues of Oregon Health & Science University, Portland. They conclude, "Use of interspinous spacers poses a trade-off in outcomes: fewer complications for the index operation, but higher rates of subsequent lumbar surgery."

Spacers for Spinal Stenosis Have Lowest Complication Rate-

The researchers compared the outcomes of three alternatives for surgical treatment of spinal stenosis in the lower (lumbar) spine. Patients with spinal stenosis have narrowing of the spinal canal, causing back pain, leg pain, and other symptoms.

The study included Medicare data on more than 99,000 Medicare patients, average age 75, who underwent surgery for spinal stenosis from 2006 to 2009. Of these, about 6,000 underwent implantation of interspinous spacers-small devices placed between vertebrae to control motion in the area affected by spinal stenosis.

Outcomes were compared with approximately 17,000 patients who underwent spinal fusion surgery to join two vertebrae together and 76,000 who underwent a simpler procedure (laminectomy) to take pressure of the spinal cord (decompression). Some patients received spacers combined with decompression.

The results showed that patients treated with spacers only had the lowest rate of major medical complications: 1.2 percent, compared to 1.8 percent with decompression and 3.3 percent with spinal fusion. Patients receiving spacers alone also spent less time in the hospital: average 1.4 days versus 2.7 days in the decompression group.

-But Higher Rate of Repeated Spinal Surgery

"Although patients receiving spacers had the lowest rate of complications, they had the highest rate of revision surgery," Dr Deyo and coauthors write. Within two years, about 17 percent of patients receiving spacers needed an additional operation on the lumbar spine, compared to 8.5 percent in the laminectomy group and about 10 percent in the fusion group.

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