title: Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study.
abstract: OBJECTIVE
  Same-level recurrent disc herniation is a well-defined complication following lumbar discectomy. Reherniation results in increased morbidity and health care costs. Techniques to reduce these consequences may improve outcomes and reduce cost after lumbar discectomy. In a prospective cohort study, we set out to evaluate the cost associated with surgical management of recurrent, same-level lumbar disc herniation following primary discectomy.
  
  
  METHODS
  Forty-six consecutive European patients undergoing lumbar discectomy for a single-level herniated disc at two institutions were prospectively followed with clinical and radiographic evaluations. A second consecutive cohort of 30 patients undergoing 31 lumbar discectomies with implantation of an annular closure device was followed at the same hospitals and same follow-up intervals. Cost estimates for reherniation were modeled on Medicare national allowable payment amounts (direct cost) and patient work-day losses (indirect cost).
  
  
  RESULTS
  Annular closure and control cohorts were matched at baseline. By 2 years follow-up, symptomatic recurrent same-level disc herniation occurred in three (6.5%) patients in the control cohort versus zero (0%) patients in the annular closure cohort. For patients experiencing recurrent disc herniation, mean estimated direct and indirect cost of management of recurrent disc herniation was $34,242 and $3,778, respectively. Use of an annular closure device potentially results in a cost savings of $222,573 per 100 primary discectomy procedures performed (or $2,226 per discectomy), based solely on the reduction of reoperated reherniations when modeled on U.S. Medicare costs.
  
  
  CONCLUSIONS
  Recurrent disc herniation did not occur in any patients after annular closure within the 12-month follow-up. The reduction in the incidence of reherniation was associated with potentially significant cost savings. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the associated morbidity and health care costs associated with this complication.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Gordan
authors.initials: G
authors.lastname: Grahovac
authors.forename: Duje
authors.initials: D
authors.lastname: Vukas
authors.forename: Darko
authors.initials: D
authors.lastname: Ledic
authors.forename: Milorad
authors.initials: M
authors.lastname: Vilendecic
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000368:Aged; D001416:Back Pain / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D017046:Cost Savings / Q000379:methods* / Q000706:statistics & numerical data; D017523:Croatia; D017586:Diskectomy / Q000191:economics* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000191:economics*; D007405:Intervertebral Disc Displacement / Q000191:economics* / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D011446:Prospective Studies; D011843:Radiculopathy / Q000209:etiology; D012086:Reoperation / Q000191:economics; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed; D014481:United States