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Decompression alone versus interspinous/interlaminar device placement for degenerative lumbar pathologies: Systematic Review and Meta-Analysis – Lumbar Spinal Stenosis

The article reviews existing literature comparing the cost and effectiveness of interspinous (ISD) and interlaminar devices (ILD) to conventional decompression surgery for degenerative lumbar pathologies. The study found that ISD/ILD showed greater improvement in leg pain at 3, 6, and 12 months, but not at 2 years or last follow-up. Back pain improvement was only better with ISD/ILD at 1 year. The study also found that patient-reported outcomes were similar between decompression-alone and ISD/ILD, with no significant clinical differences. However, ISD/ILDs were associated with higher reoperation rates and total care costs, suggesting they may not be a cost-effective alternative to decompression-alone

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

INTRODUCTION: Interspinous (ISD) and interlaminar devices (ILD) are marketed as alternatives to conventional surgery for degenerative lumbar pathologies; comparisons to decompression-alone are limited. The present study reviews the extant literature comparing cost and effectiveness of ISDs/ILDs to decompression-alone.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
World Neurosurg. 2024 Mar 18:S1878-8750(24)00439-X. doi: 10.1016/j.wneu.2024.03.054. Online ahead of print.ABSTRACTINTRODUCTION: Interspinous (ISD) and interlaminar devices (ILD) are marketed as alternatives to conventional surgery for degenerative lumbar pathologies; comparisons to decompression-alone are limited. The present study reviews the extant literature comparing cost and effectiveness of ISDs/ILDs to decompression-alone.METHODS: Articles comparing decompression-alone to ISD/ILD were identified;,

World Neurosurg. 2024 Mar 18:S1878-8750(24)00439-X. doi: 10.1016/j.wneu.2024.03.054. Online ahead of print.

ABSTRACT

INTRODUCTION: Interspinous (ISD) and interlaminar devices (ILD) are marketed as alternatives to conventional surgery for degenerative lumbar pathologies; comparisons to decompression-alone are limited. The present study reviews the extant literature comparing cost and effectiveness of ISDs/ILDs to decompression-alone.

METHODS: Articles comparing decompression-alone to ISD/ILD were identified; outcomes of interest included general and disease-specific patient-reported outcomes (PROs), perioperative complications, and total treatment costs. Outcomes were analyzed at <6 weeks, 3-months, 6-months, 1-year, 2-year, and last follow-up (LFU). Analyses were performed using random effects modeling.

RESULTS: 29 studies were included in the final analysis. ILD/ISD showed greater leg pain improvement at 3mo (-1.43; [-1.78, -1.07]; p<0.001), 6mo (-0.89; [-1.55, -0.24]; p=0.008), and 12mo (-0.97; [-1.25, -0.68]; p<0.001), but not 2yr (p=0.22) or LFU (p=0.09). Back pain improvement was better following ISD/ILD only at 1yr (-0.87; [-1.62, -0.13]; p=0.02). SF-36 physical component scores nor ZCQ symptom severity scores differed between groups. ZCQ physical function scores improved more following decompression-alone at 6mo (0.35; [0.07, 0.63]; p=0.01) and 12mo (0.23; [0.00, 0.46]; p=0.05). ODI and EQ-5D scores favored ILD/ISD at all time points except 6mo (p=0.07). Reoperations (OR=1.75; [1.23, 2.48]; p=0.002) and total care costs (standardized mean difference 1.19; [0.62, 1.77]; p<0.001) were higher in the ILD/ISD group; complications did not differ significantly between groups (p=0.41) CONCLUSION: PROs are similar following decompression-alone and ILD/ISD; the observed differences do not reach accepted minimum clinically important difference thresholds. ISD/ILDs have higher associated costs and reoperation rates, suggesting current evidence does not support ILD/ISDs as a cost-effective alternative to decompression-alone.

PMID:38508384 | DOI:10.1016/j.wneu.2024.03.054

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Decompression alone versus interspinous/interlaminar device placement for degenerative lumbar pathologies: Systematic Review and Meta-Analysis

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World Neurosurg. 2024 Mar 18:S1878-8750(24)00439-X. doi: 10.1016/j.wneu.2024.03.054. Online ahead of print.ABSTRACTINTRODUCTION: Interspinous (ISD) and interlaminar devices (ILD) are marketed as alternatives to conventional surgery for degenerative lumbar pathologies; comparisons to decompression-alone are limited. The present study reviews the extant literature comparing cost and effectiveness of ISDs/ILDs to decompression-alone.METHODS: Articles comparing decompression-alone to ISD/ILD were identified;

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