Researchers identify patients with back pain symptoms who may benefit from a specific type of lumbar fusion

May 2 2011
As the senior population in America increases in number, so does the incidence of back pain stemming from age-related degeneration. However, back conditions can strike at any age and require treatment. 

While conservative therapies are recommended as the first line of defense, not everyone benefits from stretching exercises, hot or cold compresses, or anti-inflammatory medications. Individuals whose condition warrants surgical intervention have many options, and recent studies have sought to determine the cost effectiveness of different procedures.

This type of research is important because healthcare costs in the U.S. are escalating, and the healthcare reform legislation aims to create a reimbursement system that rewards outcomes and efficiency of care delivery. In recent years, common wisdom has taken hold, which suggests that minimally invasive spine surgery is the only way to save on medical bills, but orthopedic spine surgeons, neurosurgeons and researchers are not giving up on traditional spinal fusion just yet.

In April 2011, a study was presented at the 79th Annual Scientific Meeting of the American Association of Neurological Surgeons in Denver. It focused on the cost effectiveness of transforaminal lumbar interbody fusion (TLIF) as a treatment option for spondylolisthesis.

Even though most cases of spondylolisthesis - which is defined as forward displacement or slipping of one vertebra over the one below it - occur in individuals older that 65, they can develop at any point in one's life, including at birth.

The study conducted at Vanderbilt University Medical Center in Nashville, Tennessee, included patients who were aged between 18 to 70 years, and whose MRIs showed signs of grade I degenerative lumbar spondylolisthesis that manifested itself through lower back pain with radicular symptoms. The patients who were selected had also undergone at least 6 months of unsuccessful non-surgical therapy.

Participant assessment was done before and after the surgery, and the post-operative evaluation included criteria such as low back pain and leg pain, disability and quality of life. The researchers also looked at the medical costs during the two-year period following the operation, including doctor visits, diagnostic tests, emergency room visits, medications and physical therapy. Indirect costs stemming from productivity losses and missed workdays were also taken into consideration.

The results of the study showed that two years after TLIF surgery, patient-assessed outcomes were significantly better. In particular, the participants reported less disability and improved quality of life in their questionnaires.

On the economic side, the total cost per quality adjusted life years (QALY) associated with TLIF was just under $43,000, which was under the accepted $50,000 cost-effective threshold.

However, the researchers stressed that this outcome held only for patients with back and leg pain associated with grade 1 degenerative spondylolisthesis, and did not produce similar results for those who presented mainly with back pain, and with minimum leg pain.

Dr. Matthew J. McGirt, one of the authors, stated that, in the final analysis, doctors need to work with their patients to carefully determine which procedure works best given each person's unique circumstances.

"Patient selection and surgical indication correlates closely with the procedure's efficacy and cost effectiveness and should be considered carefully," McGrit emphasized.

Results of this and similar studies may be useful for patients and their doctors nationwide in helping them make more informed decision about the course of action when conservative treatments fail to provide relief. The magnitude of this health issue is significant, as Medscape reports that lower back pain is the second most common reason for a doctor’s visit for patients with a chronic condition. Low back pain is also the fifth most common cause for hospitalizations in the U.S.