A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance

• Authors: Young Il Won, Chungnam National University Sejong Hospital; Chi Heon Kim, Seoul National University Hospital; Hee-Pyoung Park, Seoul National University; Sun Gun Chung, Seoul National University; Woon Tak Yuh, Hallym University; Shih Won Kwon, Incheon Veterans Hospital; Seung Heon Yang, Seoul National University Hospital; Chang-Huyn Lee, Seoul National University Hospital; Yunhee Choi, Seoul National University Hospital; Sung Bae Park, Seoul National University College of Medicine; John Rhee, Emory University; Kyoung-Tae Kim, Kyungpook National University Hospital; Chun Kee Chung, Seoul National University Hospital
• Journal Title: SCIENTIFIC REPORTS
• Volume: Volume 12, Number 1
• Publisher: NATURE PORTFOLIO | 2022-11-27, Pages 20408-20408
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1038/s41598-022-24784-4
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Multidisciplinary Sciences; Science & Technology - Other Topics; OSWESTRY DISABILITY INDEX; LATERAL INTERBODY FUSION; SURGICAL DECISION-MAKING; DEGENERATIVE DISEASE; OUTCOMES; SPONDYLOLISTHESIS; VALIDATION; DISORDERS; ALIGNMENT; DATABASE

Abstract

Lumbar spinal stenosis (LSS) and sagittal imbalance are relatively common in elderly patients. Although the goals of surgery include both functional and radiological improvements, the criteria of correction may be too strict for elderly patients. If the main symptom of patients is not forward-stooping but neurogenic claudication or pain, lumbar decompression without adding fusion procedure may be a surgical option. We performed cost-utility analysis between lumbar decompression and lumbar fusion surgery for those patients. Elderly patients (age > 60 years) who underwent 1–2 levels lumbar fusion surgery (F-group, n = 31) or decompression surgery (D-group, n = 40) for LSS with sagittal imbalance (C7 sagittal vertical axis, C7-SVA > 40 mm) with follow-up ≥ 2 years were included. Clinical outcomes (Euro-Quality of Life-5 Dimensions, EQ-5D; Oswestry Disability Index, ODI; numerical rating score of pain on the back and leg, NRS-B and NRS-L) and radiological parameters (C7-SVA; lumbar lordosis, LL; the difference between pelvic incidence and lumbar lordosis, PI-LL; pelvic tilt, PT) were assessed. The quality-adjusted life year (QALY) and incremental cost-effective ratio (ICER) were calculated from a utility score of EQ-5D. Postoperatively, both groups attained clinical and radiological improvement in all parameters, but NRS-L was more improved in the F-group (p = 0.048). ICER of F-group over D-group was 49,833 US dollars/QALY. Cost-effective lumbar decompression may be a recommendable surgical option for certain elderly patients, despite less improvement of leg pain than with fusion surgery.