title: Interspinous device versus laminectomy for lumbar spinal stenosis: a comparative effectiveness study.
abstract: BACKGROUND
  Currently no studies directly compare effectiveness between interspinous devices (IDs) and laminectomy in lumbar spinal stenosis (LSS) patients.
  
  
  OBJECTIVE
  To compare reoperations, complications, and costs between LSS patients undergoing ID placement versus laminectomy.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  The MarketScan database (2007-2009) was queried for adults with LSS undergoing ID placement as a primary inpatient procedure.
  
  
  METHODS
  Reoperation rates, complication rates, and costs.
  
  
  METHODS
  Each ID patient was matched with a laminectomy patient using propensity score matching. Reoperations, complications, and costs were analyzed in patients with at least 18 months postoperative follow-up. The authors did not receive funding from any external sources for this study.
  
  
  RESULTS
  Among 498 inpatients that underwent ID placement between 2007 and 2009; the average age was 73 years. The cumulative reoperation rates after ID at 12 and 18 months were 21% and 23%, respectively. The average inpatient hospitalization lasted 1.6 days with an associated cost of $17,432. Two propensity-matched cohorts of 174 patients that had undergone ID versus laminectomy were analyzed. Longer length of stay was observed in the laminectomy cohort (2.5 days vs. 1.6 days, p<.0001), whereas ID patients accrued higher costs at index hospitalization ($17,674 vs. $12,670, p=.0001). Index hospitalization (7.5% vs. 3.5%, p=.099) and 90-day (9.2% vs. 3.5%, p=.028) complications were higher in the laminectomy cohort compared with the ID cohort. The ID patients had significantly higher reoperation rates than laminectomy patients at 12 months follow-up (12.6% vs. 5.8%, p=.026) and incurred higher cumulative costs than laminectomy patients at 12 months follow-up ($39,173 vs. $34,324, p=.289).
  
  
  CONCLUSIONS
  Twelve-month reoperation rates and index hospitalization costs were significantly higher among patients who underwent ID compared with laminectomy for LSS.
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA. Electronic address: chirag.patil@cshs.org.
authors.forename: Chirag G
authors.initials: CG
authors.lastname: Patil
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: J Manuel
authors.initials: JM
authors.lastname: Sarmiento
authors.affiliation: Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Ugiliweneza
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuño
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 W. Third St, Suite 800E, Los Angeles, CA 90048, USA.
authors.forename: Sartaaj
authors.initials: S
authors.lastname: Walia
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, 200 Trent Drive, Blue Zone- Room 4529, Durham, NC 27710, USA.
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.affiliation: Department of Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Suite 1103, Louisville, KY 40202, USA; Roblex Rex VA Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007796:Laminectomy / Q000191:economics / Q000379:methods*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000191:economics / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Decompressive surgery; Interspinous device; Laminectomy; Lumbar spinal stenosis; Neurogenic claudication; Reoperation