Lumbar spinal stenosis (LSS) and sagittal imbalance are common condition for elder patients. The goal of surgery would be both functional and radiological improvement. However, achieving both goals may not be necessary for all patients. Moreover, the ...
Lumbar spinal stenosis (LSS) and sagittal imbalance are common condition for elder patients. The goal of surgery would be both functional and radiological improvement. However, achieving both goals may not be necessary for all patients. Moreover, the criteria of correction maybe too strict for elder patients. In this regards, we analyzed cost-utility analysis between lumbar decompression surgery and lumbar fusion surgery for those patients.
Elderly patients (age > 60 years old) who underwent 1 or 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 followed-up period ≥ 2 years were included. Surgical method was a posterior bilateral decompression or oblique lumbar interbody fusion. Clinical outcomes were assessed with Euro-Quality of Life-5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), and numerical rating score of pain on back (NRS-B) and leg (NRS-L). Radiological parameters were assessed with C7 SVA, lumbar lordosis (LL), difference between pelvic incidence and lumbar lordosis (PI-LL), and pelvic tilt (PT). Utility score of EQ-5D was used to calculate quality-adjusted life year (QALY). The incremental cost-effective ratio (ICER) was used to compare cost-utility between decompression and fusion surgery.
Postoperatively, both groups attained clinical improvement in all parameters, but NRS-L was more improved in F group than D group at 24 months (p = 0.048). Preoperative C7 SVAs were 78.74 mm in D group and 82.77 mm in F group (p = 0.736) and those were significantly improved to 39.67 mm and 39.54 mm at postoperative 2 years without difference between groups (p = 0.991). All other radiological parameters were improved without difference between groups (p > 0.05). The ICER of F group over D group was 41,176 US dollar/QALY.
A cost-effective lumbar decompression surgery may be a recommendable surgical option for elder patients, albeit less improvement of leg pain than fusion surgery.