Authors (including presenting author) :
Chan TK, Li WG, Wong CK, Cheng KH, Li KK, Li W
Affiliation :
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
The burden of degenerative musculoskeletal disorders presents a huge challenge to the limited health care resources, of which chronic low back pain have a major impact on the functional capacity of patients. Standard surgical treatment of symptomatic lumbar spinal stenosis is decompression with or without fusion. Our centre has been offering surgical treatment to selected patients with symptomatic lumbar spinal stenosis. However, detailed analysis of the clinical effectiveness and cost-effectiveness of decompressive surgery is lacking in our locality.
Objectives :
In this study, we determine the clinical effectiveness and cost-effectiveness of decompressive surgery versus conservative treatment for focal lumbar spinal stenosis in the local public health care setting.
Methodology :
Patients with symptomatic focal lumbar spinal stenosis from 2015 to 2016 were reviewed. They were divided into 3 groups, who received (1) decompression without fusion, (2) decompression with posterior spinal fusion and (3) conservative treatments. Minimum follow-up period was 3 years. Clinical effectiveness was evaluated by VAS (Visual Analogue Scale), ODI (Oswestry Disability Index) and the Short Form (SF)-12 health survey. The functional scores were converted to quality-adjusted life years (QALYs). Surgical costs and hospital charges were calculated using the Hospital Authority published charge rates for non-entitled persons. The incremental cost-effectiveness ratios (ICERs) were calculated and compared with the standard cost-effectiveness thresholds in UK and US.
Result & Outcome :
A total of 55 patients were included. Twenty patients received decompression without fusion, 20 received decompression with posterior spinal fusion and 15 received conservative treatment. The mean age was 68.3 year, with a male predominance (52.8%). We observed significant improvement in pain (VAS), disability (ODI), and quality of life (SF-12) at 1, 2 and 3 years after surgery, compared with conservative treatment. The operative groups achieved Minimal Clinically Important Difference (MCID), i.e. more than 11% decrease in ODI. The QALYs gained were similar between the decompression without fusion group (0.776) and posterior spinal fusion group (0.790), suggesting the two techniques were equally effective. The ICERs for both operative groups were below the US and UK funding threshold for cost-effective surgical procedures.
