Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis

Machado, Gustavo C; Maher, Christopher G.; Ferreira, Paulo H.; Harris, Ian; Deyo, Richard A.; McKay, Damien; Li, Qiang; Ferreira, Manuela L

doi:10.1097/brs.0000000000002207

Cited by 90 publications

(61 citation statements)

References 15 publications

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“…Our findings regarding fusion and decompression surgery rates are generally similar to what was previously reported in Sweden and Australia. In Norway, the proportion of fusion of all surgeries for LSS was 11.6%, while it was 12.8% in New South Wales in the years 2003-2013, and 11.1% in Sweden in the years 1987-1999 14,18 . However, the rates in Norway were substantially lower than those reported in the United States and South Korea during the 2000s…”

Section: Discussionmentioning

confidence: 97%

“…From 1979 to 1990 rates quadrupled in the United States 15 , and tripled in Sweden from 1987 to 1999 14 . In New South Wales, Australia, rates increased by 23% from 2003 to 2013 18 . In addition to temporal variations, the variation in degenerative spine surgery across geographical areas is among the highest of all surgical interventions 19,20 .…”

Section: Introductionmentioning

confidence: 99%

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The Rates of LSS Surgery in Norwegian Public Hospitals

Grøvle

Fjeld

Haugen

et al. 2019

Spine

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Study DesignRetrospective administrative database study ObjectiveTo assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013. Summary of Background DataStudies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway. MethodsA database consisting of discharges from all Norwegian public hospitals was established.Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an ICD-10 diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, i.e. spondylolisthesis or scoliosis were not included. ResultsDuring the 15-year period, 19 543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100 000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (SD 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only. ConclusionsThe rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

The Rates of LSS Surgery in Norwegian Public Hospitals

Grøvle

Fjeld

Haugen

et al. 2019

Spine

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“…Machado et al . showed that while decompression rates for lumbar spinal stenosis have doubled in the past decade in Australia, rates for decompression and fusion have quadrupled . Until recently, there were no RCT comparing fusion plus decompression to decompression alone for LSS; therefore, only the most recent review (from 2017 and rated as low quality), included evidence from an RCT (247 patients) .…”

Section: Other Degenerative Conditionsmentioning

confidence: 99%

“…Complications from spinal fusion surgery for low back pain are common. One moderate-quality review 4 estimated the rate of early surgical complications to be 16% (95% CI [12][13][14][15][16][17][18][19][20]. A more recent low-quality review 13 estimated that complications such as infections, thrombosis, nerve root injury by pedicle screw and major bleeding are much greater with surgery (relative risk (RR) 22.11 (95% CI 5.99-81.60).…”

Section: Low Back Pain and Degenerative Disc Diseasementioning

confidence: 99%

“…showed that while decompression rates for lumbar spinal stenosis have doubled in the past decade in Australia, rates for decompression and fusion have quadrupled. 14 Until recently, there were no RCT comparing fusion plus decompression to decompression alone for LSS; therefore, only the most recent review (from 2017 and rated as low quality), included evidence from an RCT (247 patients). 15 The review, which also included nonrandomised registry studies, reported no advantage of adding fusion to decompression for back pain or disability, and noted an increased rate of reoperation (RR 1.17, 95% CI 1.06-1.28, I 2 = 49.3%) and other complications (RR 1.87, 95% CI 1.18-2.96) in the fusiondecompression group compared with decompression alone.…”

Section: Other Degenerative Conditionsmentioning

confidence: 99%

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Lumbar spine fusion: what is the evidence?

Harris

Traeger

Stanford

et al. 2018

Internal Medicine Journal

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Lumbar spine fusion is a common procedure associated with a high cost burden and risk of serious complications. We aimed to summarise systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. We found no high‐quality systematic reviews and the risk of bias of the randomised controlled trials in the reviews was generally high. The available evidence does not support a benefit from spine fusion compared to non‐operative alternatives for back pain associated with degeneration. The available evidence does not support a clinical benefit from spine fusion compared to non‐operative treatment or stabilisation without fusion for thoracolumbar burst fractures. Benefits of spine fusion compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial). Better evidence is required to determine more accurately the effectiveness of spine fusion surgery for all indications. Patients contemplating spinal fusion should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.

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Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis

Ulrich

Burgstaller

Valeri³

et al. 2022

JAMA Netw Open

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IMPORTANCEOnly limited data derived from large prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for degenerative lumbar spinal stenosis (DLSS). OBJECTIVE To assess the cumulative incidence of revision surgery after 2 types of index operations-decompression alone or decompression with fusion-among patients with DLSS. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from a multicenter, prospective cohort study, the Lumbar Stenosis Outcome Study, which included patients aged 50 years or older with DLSS at 8 spine surgery and rheumatology units in Switzerland between December 2010 and December 2015. The follow-up period was 3 years. Data for this study were analyzed between October and November 2021. EXPOSURES All patients underwent either decompression surgery alone or decompression with fusion surgery for DLSS. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in the following patient-reported outcome measures: Spinal Stenosis Measure (SSM) symptom severity (higher scores indicate more pain) and physical function (higher scores indicate more disability) subscale scores and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score (lower scores indicate worse quality of life). RESULTS A total of 328 patients (165 [50.3%] men; median age, 73.0 years [IQR, 66.0-78.0 years])were included in the analysis. Of these, 256 (78.0%) underwent decompression alone and 72 (22.0%) underwent decompression with fusion. The cumulative incidence of revisions after 3 years of follow-up was 11.3% (95% CI, 7.4%-15.1%) for the decompression alone group and 13.9% (95% CI, 5.5%-21.5%) for the fusion group (log-rank P = .60). There was no significant difference in the need for revision between the 2 groups over time (unadjusted absolute risk difference, 2.

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Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis

Abstract: 3.

Cited by 90 publications

References 15 publications

The Rates of LSS Surgery in Norwegian Public Hospitals

The Rates of LSS Surgery in Norwegian Public Hospitals

Lumbar spine fusion: what is the evidence?

Incidence of Revision Surgery After Decompression With vs Without Fusion Among Patients With Degenerative Lumbar Spinal Stenosis

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