Characterized by the narrowing of the spinal canal and impingement of nerves, spinal stenosis can be severely painful and debilitating. Stenosis can be caused by vertebral bone spurs, disc herniation or ligament overgrowth in the spine.
Stenosis of the upper spine segment in the neck is called cervical stenosis; it causes intense localized pain at the area of nerve compression and refers pain, numbness, tingling and/or weakness into the arm. In the lumbar spine, the condition often leads to sciatica. If nerve damage, paralysis or loss bladder and bowel function are imminent, surgery will be performed to treat this condition.
Not all surgeries are created equal. Be sure you know your options before agreeing to a surgical procedure.
Fusion Vs. Laminectomy
By far, spinal fusion is the most popular procedure prescribed for people with stenosis. This procedure entails the use of a bone graft or other device that is placed between two or more vertebrae to fuse them together into one rigid segment. The fusion is often reinforced with multiple pieces of hardware.
Medical researchers have expressed a great deal of concern about the increasing number of spinal fusion procedures in the last 15 years, particularly among Medicare patients. Some speculate that high reimbursements for the procedures coupled with kickbacks to surgeons from hardware device companies like Medtronics rather than the patients' best interests are responsible for the choice to perform the procedure.
A 2010 study sought to analyze trends of spinal fusion procedures while comparing this type of surgery to another, laminectomy, in the treatment of older Medicare patients with spinal stenosis. The study reports that the rate of complex spinal fusions - those involving fusion of more than two vertebrae or entailing both posterior and anterior approaches - performed between 2002 and 2007 increased 15-fold. Rates of laminectomy procedures decreased during this time.
Laminectomy, or surgical decompression, involves the removal of a piece of the posterior vertebra that covers spinal nerves. During a laminectomy, bone spurs or spinal disc segments impinging nerves are removed as well. The procedure widens the spinal canal, aiming to relieve painful pressure on nerves.
The study results showed that the rate of life-threatening complications was 2.3% among laminectomy patients and 5.6% for complex fusion patients. Rehospitalization rates within 30 days of the procedure were 7.8% for laminectomy recipients and 13% for complex fusion recipients. Complex fusions cost nearly 4 times more than laminectomies ($80,888 compared to $23,724). See more on the study at http://www.ncbi.nlm.nih.gov/pubmed/20371784.
Another study sought to compare the cost-effectiveness of both procedures for stenosis patients. Some cases of stenosis cannot be treated with laminectomy, particularly those that involve vertebral slipping (spondylolisthesis). Researchers compared the cost-effectiveness of laminectomy for regular stenosis to that of fusion for stenosis with vertebral slipping. Cost-effectiveness was measured in quality-adjusted life-years (QALY). Laminectomy cost $77,000 per QALY gained, compared to $115,000 for fusions. In the U.S., procedures are considered cost-effective up to $100,000 per QALY. See more on the study at http://annals.org/article.aspx?articleid=744151.
Despite the low cost-effectiveness, it is important to note that the above study also showed fusion for stenosis patients with spondylolisthesis to yield significantly greater health improvements than nonoperative care.
The decision to have surgery should not be an easy one. It is important for both patients and health professionals to ensure that conservative treatments have been rigorously pursued, if possible, and that surgery is a necessary last resort. For those with stenosis without vertebral slipping, laminectomy appears to be the best surgical option. Inform yourself about all your options before having surgery.
No comments:
Post a Comment