Cost-Effectiveness of Spine Surgery: The Jury Is Out
Authors: Jeffrey N. Katz
Journal: Annals of Internal Medicine (2008)

EditorialsDecember 16, 2008Cost-Effectiveness of Spine Surgery: The Jury Is OutJeffrey N. Katz, MD, MSc and Elena Losina, PhDJeffrey N. Katz, MD, MScFrom Brigham and Women's Hospital, Boston, MA 02115.Search for more papers by this author and Elena Losina, PhDFrom Brigham and Women's Hospital, Boston, MA 02115.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-12-200812160-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Back pain affects more than 80% of persons and costs more than $100 billion annually in the United States (1). Although most patients with low back pain can be managed nonoperatively, spine surgery is an important option for patients with disabling herniated nucleus pulposus, lumbar spinal stenosis, or spondylolisthesis with stenosis. More than 650 000 surgical procedures are performed annually for these disorders in the United States, at a cost exceeding $20 billion (2, 3). Whether this investment provides good value is largely unknown.In this issue, Tosteson and colleagues (4) investigate the cost-effectiveness of surgery for spinal stenosis. This work ...References1. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88: 21-4. [PMID: 16595438] MedlineGoogle Scholar2. Agency for Healthcare Research and Quality. HCUPnet, Healthcare Cost and Utilization Project. Rockville, MD Agency for Healthcare Research and Quality 2002. Google Scholar3. Deyo RA. Back surgery—who needs it? N Engl J Med. 2007;356:2239-43. [PMID: 17538083] CrossrefMedlineGoogle Scholar4. Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, et al. Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med. 2008;149:845-53. LinkGoogle Scholar5. Appleby J, Devlin N, and Parkin D. NICE's cost effectiveness threshold [Editorial]. BMJ. 2007;335:358-9. [PMID: 17717337] CrossrefMedlineGoogle Scholar6. Siegel JE, Weinstein MC, Russell LB, and Gold MR. Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine. JAMA. 1996;276:1339-41. [PMID: 8861994] CrossrefMedlineGoogle Scholar7. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, and Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA. 1996;276:1253-8. [PMID: 8849754] CrossrefMedlineGoogle Scholar8. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356:2257-70. [PMID: 17538085] CrossrefMedlineGoogle Scholar9. Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451-9. [PMID: 17119141] CrossrefMedlineGoogle Scholar10. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. SPORT Investigators. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810. [PMID: 18287602] CrossrefMedlineGoogle Scholar11. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. 2006;296:2441-50. [PMID: 17119140] CrossrefMedlineGoogle Scholar12. Miller FG. Sham surgery: an ethical analysis. Sci Eng Ethics. 2004;10:157-66. [PMID: 14986782] CrossrefMedlineGoogle Scholar13. Fortin PR, Clarke AE, Joseph L, Liang MH, Tanzer M, Ferland D, et al. Outcomes of total hip and knee replacement: preoperative functional status predicts outcomes at six months after surgery. Arthritis Rheum. 1999;42:1722-8. [PMID: 10446873] CrossrefMedlineGoogle Scholar14. Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, and Liang MH. Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine. 1996;21:92-8. [PMID: 9122770] CrossrefMedlineGoogle Scholar15. Kuntz KM, Snider RK, Weinstein JN, Pope MH, and Katz JN. Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Spine. 2000;25:1132-9. [PMID: 10788859] CrossrefMedlineGoogle Scholar16. Malter AD, Larson EB, Urban N, Deyo RA. Cost-effectiveness of lumbar discectomy for the treatment of herniated intervertebral disc. Spine. 1996;21:1048-54; discussion 1055. [PMID: 8724089] Google Scholar Author, Article, and Disclosure InformationAffiliations: From Brigham and Women's Hospital, Boston, MA 02115.Disclosures: None disclosed.Corresponding Author: Jeffrey N. Katz, MD, MSc, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, OBC-4, Boston, MA 02115; e-mail, [email protected].Current Author Addresses: Drs. Katz: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, OBC-4, Boston, MA 02115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSurgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years Anna N.A. Tosteson , Jon D. Lurie , Tor D. Tosteson , Jonathan S. Skinner , Harry Herkowitz , Todd Albert , Scott D. Boden , Keith Bridwell , Michael Longley , Gunnar B. Andersson , Emily A. Blood , Margaret R. Grove , James N. Weinstein , and Metrics December 16, 2008Volume 149, Issue 12Page: 901-903KeywordsCohort studiesFactor analysisLower back painObservational studiesOrthopedicsQuestionnairesSpineSportsStatistical methodsStenosisSurgeonsSurgery ePublished: 16 December 2008 Issue Published: December 16, 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...