Written by Laura Dyrda | Friday, 01 August 2014

An article recently published in the Journal of Neurosurgery: Spine examines the medical management of lumbar spine disease to find cost and quality value two years after surgery.
The researchers examined 50 patients with lumbar spondylolisthesis, 50 patients with stenosis and 50 patients with disc herniation. All patients had persisting systems after six weeks of medical management and were eligible for surgical treatment. The patients were entered into a prospective registry after deciding on non-surgical treatment.

The researchers found:

1. Maximum health gain in back pain, leg pain, disability, quality of life, depression and general health state did not achieve statistical significance after two years of medical management in most cases. The exception was pain and disability in patients with disc herniation and back pain in patients with lumbar stenosis.

2. There were several patients that required surgical management eventually due to lack of improvement. By condition, the percentage of patients who eventually underwent surgery was:

• Spondylolisthesis: 36 percent
• Stenosis: 11 percent
• Disc herniation: 34 percent

3. The two-year improvement didn’t achieve a minimum clinically important difference in any outcome measure. These findings could have an impact on how similar cases are hanlded in the future. “The findings from this real-world practice setting may more accurately reflect the true value and effectiveness of nonoperative care in surgically eligible patient populations,” concluded the study authors.

4. The average cost—direct and indirect—of medical management after two years was:

• Spondylolisthesis: $6,606
• Stenosis: $7,747
• Herniation: $7,097

5. The study authors concluded, “From both the societal and payer prospective, continued medical management of patients with these lumbar pathologies in whom six weeks of conservative therapy failed was of minimal value given its lack of health utility and effectiveness and its healthcare costs.”