Minimally Invasive, Open Hemilaminectomy Equivalent
(HealthDay News) – Minimally invasive (MIS) and open multilevel hemilaminectomy are similar with respect to cost and improved quality of life measures for the treatment of degenerative lumbar spinal stenosis, according to a study published in the February issue of the Journal of Spinal Disorders & Techniques.
Scott L. Parker, MD, from the Vanderbilt University Medical Center in Nashville, TN, and colleagues conducted a two-year cost-utility study for 54 consecutive patients with lumbar stenosis undergoing multilevel hemilaminectomy through an MIS paramedian tubular approach or midline open approach (27 patients in each group). After two years, total back-related medical resource utilization, missed work, and health state values (quality-adjusted life-years [QALYs]) were assessed. The direct costs (resource use multiplied by unit costs based on Medicare national allowable payment amounts) and indirect costs (work-day losses multiplied by the self-reported gross-of-tax wage rate) were assessed.
The researchers found that, two years after surgery, MIS and open hemilaminectomy were associated with an equivalent cumulative gain of 0.72QALYs. MIS and open hemilaminectomy were similar with respect to mean direct medical costs, indirect societal costs, and total two-year cost ($23,109 and $25,420, respectively; P = 0.21). Total costs and utility were similar for the MIS vs. open approach.
"MIS vs. open multilevel hemilaminectomy was associated with similar cost over two years while providing equivalent improvement in QALYs," the authors write. "In our experience, MIS vs. open multilevel hemilaminectomy techniques are equally effective at long-term pain relief and provide equivalent benefit in long-term functional capacity and quality of life."