Turkish Neurosurgery 2019 , Vol 29 , Num 5
A Simple Cost-Effectiveness Analysis of Bilateral Decompression via Unilateral Approach versus Instrumented Total Laminectomy and Fusion for Lumbar Spinal Stenosis
Ali Erhan KAYALAR1,Mehmet Resid ONEN1,Aydin GERILMEZ2,Sait NADERI1
1University of Health Sciences, Umraniye Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
2University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Department of Neurosurgery, Istanbul, Turkey
DOI : 10.5137/1019-5149.JTN.24318-18.1 AIM: To compare the clinical and economic results of two different surgical approaches (bilateral decompression via unilateral approach and instrumented total laminectomy and fusion) in the treatment of lumbar spinal stenosis.

MATERIAL and METHODS: The clinical, surgical, and economic aspects of 100 surgically treated patients with lumbar spinal stenosis were retrospectively reviewed.

RESULTS: Decompression was performed at 158 levels in 100 patients. The most commonly decompressed levels were L4-5 and L3-4. Significant difference was observed between pre- and postoperative visual analog scale scores in both groups (p<0.05). In Group 1 (instrumented total laminectomy and fusion), the mean surgery cost was 2539.2 USD (mean procedure cost: 1440.1 USD, mean implant cost: 1099.2 USD). In Group 2 (bilateral decompression via unilateral approach) the mean surgery cost was 998.5 USD. The cost difference was significant (p<0.05).

CONCLUSION: Both instrumented total laminectomy and fusion and bilateral decompression via unilateral approach performed with and without stabilization showed similar clinical results in patients with lumbar spinal stenosis. However, the cost of surgery was found to be 2.5-fold higher in the instrumented total laminectomy and fusion group. This study supports the concept that minimally invasive spine surgery is cost-effective. Keywords : Cost effectiveness, Economy, Lumbar spinal stenosis, Surgery

Corresponding author : Ali Erhan KAYALAR, draekayalar@gmail.com