The Trade-Offs of Spinal Surgeries

Interspinous spacers for spinal stenosis led to fewer complications but more revision surgeries

(RxWiki News) As people age, their spines can go through a fair amount of wear and tear which, in some cases, can lead to spinal stenosis. Surgery isn't necessary for every spinal stenosis patient, but when it is, which procedure should patients choose?

In a recent study, researchers compared one type of spinal surgery – called interspinous distraction – to two other more invasive surgeries for spinal stenosis.

The researchers found that spinal stenosis patients who underwent interspinous distraction had fewer complications than those who underwent decompression surgery or spinal fusion.

However, interspinous distraction patients were more likely to need a repeat back surgery.

"Discuss your options before surgery."

Spinal stenosis is a narrowing of the small spinal canal that contains the nerve roots and spinal cord. This narrowing can put press on the spinal cord and nerves, which can lead to pain, numbness, weakness and other symptoms depending on what part of the spine the narrowing takes place.

Some patients with spinal stenosis have no signs or symptoms. Others require medications or physical therapy to control symptoms. In severe cases, patients may undergo surgery to make more space for the spinal cord or nerves.

For this recent study, Richard A. Deyo, MD, MPH, and his fellow researchers from Oregon Health & Science University in Portland, Oregon set out to see if interspinous distraction procedures were associated with fewer complications, lower costs and fewer repeated surgeries than decompression surgery or spinal fusion surgery.

These researchers also looked at whether interspinous distraction was used selectively in older patients or those with other health conditions beyond spinal stenosis.

Interspinous distraction surgery is a procedure that involves implanting small devices called interspinous spacers between parts of the vertebrae. These spaces open up the narrowed portions of the space while also restricting painful motion but allowing normal motion.

Decompression surgery, formally known as laminectomy, is a procedure in which the lamina (back part of the vertebra that covers the spinal canal) is removed to relieve pressure on the spinal cord and nerves.

Spinal fusion is surgery to permanently join together two or more vertebrae so there cannot be any more movement between them. In most cases, patients undergo other surgery, such as decompression surgery, before spinal fusion.

Dr. Deyo and colleagues looked at Medicare data to identify 99,084 spinal stenosis patients who had some form of these surgeries between 2006 and 2009. About 6,000 of these patients received interspinous spacers, about 76,000 underwent decompression surgery and about 17,000 underwent spinal fusion surgery.

Some patients underwent both spacer implantation and decompression.

The researchers found that patients who received interspinous spacers tended to be older than patients who underwent decompression or fusion surgery. There was little evidence, however, that spacers were used selectively in patients with multiple health problems.

Rates of major complications were lower among patients who received a spacer alone than those who underwent either of the other surgeries. Specifically, 1.2 percent of patients who received spacers experienced major complications, compared to 1.8 percent of decompression surgery patients and 3.3 percent of fusion surgery patients.

Despite their lower rates of complications, patients who received a spacer alone had higher rates of repeat lower back surgery. In the two years following the initial surgery, 16.7 percent of patients who received spacers required a repeat surgery, compared to 8.5 percent of decompression surgery patients and 9.8 percent of fusion surgery patients.

The researchers also found that hospital payments for spacer surgery were higher than those for decompression surgery alone but less than for spinal fusion surgery.

Costs of decompression surgery in the United States can range from about $8,000 to more than $25,000.

According to a press statement about this study, the researchers said that the higher rate of repeat surgery with spacers may support the choice of decompression surgery for patients at average risk. Spacers, however, may be a good option for older patients with higher surgery risks.

"Compared with decompression or fusion, interspinous distraction procedures pose a trade-off in outcomes: fewer complications for the index [first] operation, but higher rates of revision [repeat] surgery," wrote Dr. Deyo and team.

The authors concluded that these findings should help patients make more informed decisions about their surgery options. However, more research is needed.

This study was published May 1 in the journal Spine. Information on funding and author disclosures were unavailable.

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Review Date: 
May 6, 2013