棘突间减压术的成本效益和安全性

K. Cairns, Timothy Deer, Dawood Sayed, Kim van Noort, Kevin Liang
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引用次数: 13

摘要

摘要目的腰椎管狭窄症的治疗方法包括手术治疗和保守治疗。使用Superion装置进行棘间间隔减压为传统减压手术前保守治疗失败的患者提供了一种侵入性较小的方法。本综述评估了目前与Superion棘间间隔器手术相比,腰椎管狭窄治疗方式的成本效益、安全性和性能。方法检索EMBASE和PubMed,查找保守治疗(包括药物治疗、硬膜外注射、物理治疗和替代方法)以及手术治疗(包括椎板切除术、椎板切除术融合术和棘间间隔器减压)的成本-效果、安全性和性能的研究报告。人工搜索补充了结果。结果:尽管花费巨大,腰椎管狭窄的持续保守治疗(>12周)仅显示疼痛和功能的微小改善。当保守治疗失败时,手术比继续保守治疗更有效。腰椎椎板切除术合并融合比单纯椎板切除术的成本要高得多,因为住院时间增加,植入物的成本也很高,并发症也增加。虽然椎板切除术和Superion的结果相当,但Superion植入物是经皮定位的。这种方法可以最大限度地减少门诊康复和缺勤的直接和间接成本。结论对于保守治疗失败的腰椎管狭窄患者,超棘突间腰椎减压术是一种微创手术。与扩大保守治疗或传统脊柱手术相比,棘突间腰椎减压可减少腰椎管狭窄相关的直接和间接费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)
Abstract Objective There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure. Methods EMBASE and PubMed were searched to find studies reporting on the cost-effectiveness, safety, and performance of conservative treatment, including medicinal treatments, epidural injections, physical therapy, and alternative methods, as well as surgical treatment, including laminectomy, laminectomy with fusion, and interspinous spacer decompression. Results were supplemented with manual searches. Results Despite substantial costs, persistent conservative treatment (>12 weeks) of lumbar spinal stenosis showed only minimal improvement in pain and functionality. When conservative treatment fails, surgery is more effective than continuing conservative treatment. Lumbar laminectomy with fusion has considerably greater cost than laminectomy alone, as the length of hospital stay increases, the costs for implants are substantial, and complications increase. Although laminectomy and the Superion have comparable outcomes, the Superion implant is positioned percutaneously. This approach may minimize the direct and indirect costs of outpatient rehabilitation and absenteeism, respectively. Conclusions Superion interspinous lumbar decompression is a minimally invasive procedure for patients with lumbar spinal stenosis who have failed conservative treatment. Compared with extending conservative treatment or traditional spinal surgery, interspinous lumbar decompression reduces the direct and indirect costs associated with lumbar spinal stenosis.
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