Arthrodesis ups complications, costs for spondylolisthesis

(HealthDay)—For patients with lumbar spondylolisthesis, decompressive laminectomy and spinal arthrodesis is associated with lower reoperation rates, but with higher complication rates and higher overall costs than laminectomy alone, according to a study published in the Nov. 6 issue of The Journal of Bone & Joint Surgery.

Shivanand P. Lad, M.D., Ph.D., from the Duke University Medical Center in Durham, N.C., and colleagues examined complications, reoperation rates, and health care-associated costs for 16,556 patients with a primary diagnosis of lumbar spondylolisthesis who underwent surgical treatment from 2000 to 2009, identified from the MarketScan database.

The researchers found that, compared with patients undergoing decompression alone, patients undergoing arthrodesis had significantly higher complication rates during the initial hospitalization (8.3 versus 4.8 percent; P < 0.0001) and at the 90-day follow-up (9.6 versus 5.5 percent; P < 0.0001), with no difference for instrumented versus noninstrumented arthrodesis. The rates of reoperation at ≥ two years were higher in patients who underwent decompression alone versus those who received arthrodesis (15.7 versus 11.9 percent; P = 0.034). Patients managed with arthrodesis had higher initial hospital costs and two-year and five-year overall costs (in 2009 U.S. dollars) than those who had decompression only ($102,906 versus $89,337; P = 0.0018).

"The long-term outcomes and costs of these procedures should be evaluated in conjunction with clinical efficacy to ensure the most cost-effective treatment is utilized," the authors conclude.

One or more authors disclosed a financial relationship with an entity in the biomedical arena.