Cost-effectiveness of decompression according to Gill versus instrumented spondylodesis in the treatment of sciatica due to low grade spondylolytic spondylolisthesis: a prospective randomised controlled trial [NTR1300].
BACKGROUND
Nerve root decompression with instrumented spondylodesis is the most frequently performed surgical procedure in the treatment of patients with symptomatic low-grade spondylolytic spondylolisthesis. Nerve root decompression without instrumented fusion, i.e. Gill's procedure, is an alternative and less invasive approach. A comparative cost-effectiveness study has not been performed yet. We present the design of a randomised controlled trial on cost-effectiveness of decompression according to Gill versus instrumented spondylodesis.


METHODS
All patients (age between 18 and 70 years) with sciatica or neurogenic claudication lasting more than 3 months due to spondylolytic spondylolisthesis grade I or II, are eligible for inclusion. Patients will be randomly allocated to nerve root decompression according to Gill, either unilateral or bilateral, or pedicle screw fixation with interbody fusion. The main primary outcome measure is the functional assessment of the patient measured with the Roland Disability Questionnaire for Sciatica at 12 weeks and 2 years. Other primary outcome measures are perceived recovery and intensity of leg pain and low back pain. The secondary outcome measures include, incidence of re-operations, complications, serum creatine phosphokinase, quality of life, medical consumption, costs, absenteeism, work perception, depression and anxiety, and treatment preference. The study is a randomised prospective multicenter trial in which two surgical techniques are compared in a parallel group design. Patients and research nurse will not be blinded during the follow-up period of 2 years.


CONCLUSIONS
Currently, nerve root decompression with instrumented fusion is the golden standard in the surgical treatment of low-grade spondylolytic spondylolisthesis, although scientific proof justifying instrumented spondylodesis over simple decompression is lacking. This trial is designed to elucidate the controversy in best surgical treatment of symptomatic patients with low-grade spondylolytic spondylolisthesis.
Arts
Mark P
MP
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands. m.arts@mchaaglanden.nl
Verstegen
Marco J T
MJ
Brand
Ronald
R
Koes
Bart W
BW
van den Akker
M Elske
ME
Peul
Wilco C
WC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D003362:Cost-Benefit Analysis; D003402:Creatine Kinase / Q000097:blood; D019299:Decompression, Surgical / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D003863:Depression; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012585:Sciatica / Q000191:economics / Q000209:etiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D013168:Spondylolisthesis / Q000150:complications*; D055815:Young Adult
D003402:Creatine Kinase