Utilization of spinal cord stimulation in patients with failed back surgery syndrome.
METHODS
Retrospective analysis of a population-based insurance claims data set.


OBJECTIVE
To evaluate the use of spinal cord stimulation (SCS) and lumbar reoperation for the treatment of failed back surgery syndrome (FBSS), and examine their associated complications and health care costs.


BACKGROUND
FBSS is a major source of chronic neuropathic pain and affects up to 40% of patients who undergo lumbosacral spine surgery for back pain. Thus far, few economic analyses have been performed comparing the various treatments for FBSS, with these studies involving small sample sizes. In addition, the nationwide practices in the use of SCS for FBSS are unknown.


METHODS
The MarketScan data set was used to analyze patients with FBSS who underwent SCS or spinal reoperation between 2000 and 2009. Propensity score methods were used to match patients who underwent SCS with those who underwent lumbar reoperation to examine health care resource utilization. Postoperative complications were analyzed with multivariate logistic regression. Health care use was analyzed using negative binomial and general linear models.


RESULTS
The study cohort included 16,455 patients with FBSS, with 395 undergoing SCS implantation (2.4%). Complication rates at 90 days were significantly lower for SCS than spinal reoperation (P < 0.0001). Also in the matched cohort, hospital stay (P < 0.0001) and associated charges (P = 0.016) were lower for patients with SCS. However outpatient, emergency room, and medication charges were similar between the 2 groups. Overall cost totaling $82,586 at 2 years was slightly higher in the lumbar reoperation group than in the SCS group with total cost of $80,669 (P = 0.88).


CONCLUSIONS
Although previous studies have demonstrated superior efficacy for the treatment of FBSS, SCS remains underused. Despite no significant decreases in overall health care cost with SCS implantation, because it is associated with decreased complications and improved outcomes, this technology warrants closer consideration for the management of chronic pain in patients with FBSS.
*Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC †Department of Neurosurgery, University of Louisville, Louisville, KY; and ‡Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Shivanand P
SP
Lad
Ranjith
R
Babu
Jacob H
JH
Bagley
Jonathan
J
Choi
Carlos A
CA
Bagley
Billy K
BK
Huh
Beatrice
B
Ugiliweneza
Chirag G
CG
Patil
Maxwell
M
Boakye
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D000700:Analgesics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D055111:Failed Back Surgery Syndrome / Q000191:economics / Q000601:surgery / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000191:economics / Q000209:etiology / Q000628:therapy*; D059408:Pain Management / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000191:economics; D012189:Retrospective Studies; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data*
D000700:Analgesics