Journal of Neurosurgery: Spine. July 2010, Volume 13, Number 1

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

Mark G. Burnett, M.D.1, Sherman C. Stein, M.D.2, and Ronald H. M. A. Bartels, M.D., Ph.D.3. 1Department of Neurosurgery, NeuroTexas Institute, Austin, Texas; 2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania; and 3Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Nijmegan, The Netherlands. ©1944-2010 by the American Association of Neurosurgeons.

Abbreviations used in this paper: HRQOL = health-related quality of life; LSS = lumbar spinal stenosis; QALY = quality-adjusted life year; SF-36 = 36-Item Short Form Health Survey.

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.