Longitudinal Analysis of the Care Pathway of Patients with Lumbar Spinal Stenosis in the US

Overview

Journal J Pain Res

Publisher Dove Medical Press

Date 2024 Jun 10

PMID 38854929

Authors

Ramana K Naidu

Oth V Tran

Michael E Schatman

Affiliations

Soon will be listed here.

Abstract

Background: Evidence regarding the frequency and timing of treatment for lumbar spinal stenosis (LSS) fails to offer clear consensus. We describe the LSS care journey from initial diagnosis to first surgical intervention.

Methods: Using Medicare claims database from 2009 through 2020, we identified patients who were diagnosed with LSS. The use and timing of conservative and surgical treatments during the entire follow-up from the initial diagnosis were reported.

Results: Of the 143,849 patients identified, 68% received conservative care within 8.4 months and 25.3% received a surgical or minimally invasive intervention over 5.7 years following initial diagnosis, with 12.6% undergoing open decompression alone, 10.2% undergoing open decompression with fusion, and 5.1% undergoing fusion surgery alone. Fewer than 1% were provided with interspinous spacers or a percutaneous image-guided lumbar decompression.

Conclusion: Approximately three-quarters of patients in the study received no surgical or non-invasive interventions for approximately six years following diagnosis with LSS.

References

Cairns K, Deer T, Sayed D, van Noort K, Liang K . Cost-effectiveness and Safety of Interspinous Process Decompression (Superion). Pain Med. 2019; 20(Suppl 2):S2-S8. PMC: 6896024. DOI: 10.1093/pm/pnz245. View

Ciricillo S, Weinstein P . Lumbar spinal stenosis. West J Med. 1993; 158(2):171-7. PMC: 1021971. View

Nunley P, Patel V, Orndorff D, Lavelle W, Block J, Geisler F . Interspinous Process Decompression Improves Quality of Life in Patients with Lumbar Spinal Stenosis. Minim Invasive Surg. 2018; 2018:1035954. PMC: 6051048. DOI: 10.1155/2018/1035954. View

Bagley C, MacAllister M, Dosselman L, Moreno J, Aoun S, El Ahmadieh T . Current concepts and recent advances in understanding and managing lumbar spine stenosis. F1000Res. 2019; 8. PMC: 6357993. DOI: 10.12688/f1000research.16082.1. View

Matsudaira K, Hara N, Oka H, Kunogi J, Yamazaki T, Takeshita K . Predictive Factors for Subjective Improvement in Lumbar Spinal Stenosis Patients with Nonsurgical Treatment: A 3-Year Prospective Cohort Study. PLoS One. 2016; 11(2):e0148584. PMC: 4749385. DOI: 10.1371/journal.pone.0148584. View

Miyamoto H, Sumi M, Uno K, Tadokoro K, Mizuno K . Clinical outcome of nonoperative treatment for lumbar spinal stenosis, and predictive factors relating to prognosis, in a 5-year minimum follow-up. J Spinal Disord Tech. 2008; 21(8):563-8. DOI: 10.1097/BSD.0b013e31815d896c. View

Battie M, Jones C, Schopflocher D, Hu R . Health-related quality of life and comorbidities associated with lumbar spinal stenosis. Spine J. 2011; 12(3):189-95. DOI: 10.1016/j.spinee.2011.11.009. View

Kalichman L, Cole R, Kim D, Li L, Suri P, Guermazi A . Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009; 9(7):545-50. PMC: 3775665. DOI: 10.1016/j.spinee.2009.03.005. View

Burnett M, Stein S, Bartels R . Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. J Neurosurg Spine. 2010; 13(1):39-46. DOI: 10.3171/2010.3.SPINE09552. View

10.

Bini W, Miller L, Block J . Minimally invasive treatment of moderate lumbar spinal stenosis with the superion interspinous spacer. Open Orthop J. 2011; 5:361-7. PMC: 3201565. DOI: 10.2174/1874325001105010361. View

11.

Whang P, Tran O, Rosner H . Longitudinal Comparative Analysis of Complications and Subsequent Interventions Following Stand-Alone Interspinous Spacers, Open Decompression, or Fusion for Lumbar Stenosis. Adv Ther. 2023; 40(8):3512-3524. PMC: 10329952. DOI: 10.1007/s12325-023-02562-6. View

12.

Li G, Patil C, Lad S, Ho C, Tian W, Boakye M . Effects of age and comorbidities on complication rates and adverse outcomes after lumbar laminectomy in elderly patients. Spine (Phila Pa 1976). 2008; 33(11):1250-5. DOI: 10.1097/BRS.0b013e3181714a44. View

13.

Deyo R, Mirza S, Martin B, Kreuter W, Goodman D, Jarvik J . Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010; 303(13):1259-65. PMC: 2885954. DOI: 10.1001/jama.2010.338. View

14.

Diwan S, Sayed D, Deer T, Salomons A, Liang K . An Algorithmic Approach to Treating Lumbar Spinal Stenosis: An Evidenced-Based Approach. Pain Med. 2019; 20(Suppl 2):S23-S31. PMC: 7101167. DOI: 10.1093/pm/pnz133. View

15.

Xu S, Wang J, Liang Y, Zhu Z, Wang K, Qian Y . Decompression with fusion is not in superiority to decompression alone in lumbar stenosis based on randomized controlled trials: A PRISMA-compliant meta-analysis. Medicine (Baltimore). 2019; 98(46):e17849. PMC: 6867750. DOI: 10.1097/MD.0000000000017849. View

16.

Nunley P, Patel V, Orndorff D, Lavelle W, Block J, Geisler F . Superion Interspinous Spacer Treatment of Moderate Spinal Stenosis: 4-Year Results. World Neurosurg. 2017; 104:279-283. DOI: 10.1016/j.wneu.2017.04.163. View

17.

Deyo R, Cherkin D, Ciol M . Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992; 45(6):613-9. DOI: 10.1016/0895-4356(92)90133-8. View

18.

Ziino C, Mertz K, Hu S, Kamal R . Decompression With or Without Fusion for Lumbar Stenosis: A Cost Minimization Analysis. Spine (Phila Pa 1976). 2020; 45(5):325-332. DOI: 10.1097/BRS.0000000000003250. View

19.

Deer T, Grider J, Pope J, Falowski S, Lamer T, Calodney A . The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract. 2018; 19(3):250-274. DOI: 10.1111/papr.12744. View

20.

Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney A . A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. Pain Med. 2019; 20(Suppl 2):S32-S44. PMC: 7101166. DOI: 10.1093/pm/pnz161. View