But Higher Rate of Repeated Spinal Surgery
"Although patients receiving spacers had the lowest rate of complications, they had the highest rate of revision surgery," Dr Deyo and coauthors write. Within two years, about 17 percent of patients receiving spacers needed an additional operation on the lumbar spine, compared to 8.5 percent in the laminectomy group and about 10 percent in the fusion group.
Patients receiving spacers tended to be older and to have other medical problems. With adjustment for these and other factors, patients in the spacer group were more than twice as likely to require repeat surgery. "Hospital payments for spacer surgery were greater for decompression alone, but less than for fusion procedures," the researchers write.
Previous studies have found that interspinous spacers are an effective treatment for patients with lumbar spinal stenosis, compared to nonsurgical care. However, no studies have directly compared the outcomes of interspinous spacers with other surgical procedures for spinal stenosis.
Since spacer implantation is less-invasive, it's not surprising to learn that it has a lower complication than more extensive surgical procedures. However, the new results suggest that spacers carry a "substantially greater likelihood" of requiring further surgery later on.
The authors discuss the trade-offs among complications, costs, and repeat surgery. For patients at average risk, "the higher reoperation rate with spacers may argue in favor of conventional decompression surgery," the researchers write. Spacers might be a good alternative for older patients with higher surgical risks.
Dr Deyo and coautho
|Contact: Connie Hughes|
Wolters Kluwer Health