Utilization of spinal cord stimulation in patients with failed back surgery syndrome

Shivanand P. Lad, Ranjith Babu, Jacob H. Bagley, Jonathan Choi, Carlos A. Bagley, Billy K. Huh, Beatrice Ugiliweneza, Chirag G. Patil, Maxwell Boakye

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective analysis of a population-based insurance claims data set. OBJECTIVE.: To evaluate the use of spinal cord stimulation (SCS) and lumbar reoperation for the treatment of failed back surgery syndrome (FBSS), and examine their associated complications and health care costs. SUMMARY OF BACKGROUND DATA.: FBSS is a major source of chronic neuropathic pain and affects up to 40% of patients who undergo lumbosacral spine surgery for back pain. Thus far, few economic analyses have been performed comparing the various treatments for FBSS, with these studies involving small sample sizes. In addition, the nationwide practices in the use of SCS for FBSS are unknown. METHODS.: The MarketScan data set was used to analyze patients with FBSS who underwent SCS or spinal reoperation between 2000 and 2009. Propensity score methods were used to match patients who underwent SCS with those who underwent lumbar reoperation to examine health care resource utilization. Postoperative complications were analyzed with multivariate logistic regression. Health care use was analyzed using negative binomial and general linear models. RESULTS.: The study cohort included 16,455 patients with FBSS, with 395 undergoing SCS implantation (2.4%). Complication rates at 90 days were significantly lower for SCS than spinal reoperation (P < 0.0001). Also in the matched cohort, hospital stay (P < 0.0001) and associated charges (P = 0.016) were lower for patients with SCS. However outpatient, emergency room, and medication charges were similar between the 2 groups. Overall cost totaling $82,586 at 2 years was slightly higher in the lumbar reoperation group than in the SCS group with total cost of $80,669 (P = 0.88). CONCLUSION.: Although previous studies have demonstrated superior efficacy for the treatment of FBSS, SCS remains underused. Despite no significant decreases in overall health care cost with SCS implantation, because it is associated with decreased complications and improved outcomes, this technology warrants closer consideration for the management of chronic pain in patients with FBSS.

Original languageEnglish (US)
JournalSpine
Volume39
Issue number12
DOIs
StatePublished - May 20 2014

Fingerprint

Failed Back Surgery Syndrome
Spinal Cord Stimulation
Reoperation
Chronic Pain
Health Care Costs
Patient Acceptance of Health Care
Costs and Cost Analysis
Propensity Score
Health Resources
Neuralgia
Back Pain
Insurance
Sample Size
Hospital Emergency Service
Linear Models
Length of Stay
Spine
Cohort Studies
Outpatients

Keywords

  • complications
  • failed back surgery syndrome
  • health care cost
  • lumbar reoperation
  • spinal cord stimulation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Utilization of spinal cord stimulation in patients with failed back surgery syndrome. / Lad, Shivanand P.; Babu, Ranjith; Bagley, Jacob H.; Choi, Jonathan; Bagley, Carlos A.; Huh, Billy K.; Ugiliweneza, Beatrice; Patil, Chirag G.; Boakye, Maxwell.

In: Spine, Vol. 39, No. 12, 20.05.2014.

Research output: Contribution to journalArticle

Lad, SP, Babu, R, Bagley, JH, Choi, J, Bagley, CA, Huh, BK, Ugiliweneza, B, Patil, CG & Boakye, M 2014, 'Utilization of spinal cord stimulation in patients with failed back surgery syndrome', Spine, vol. 39, no. 12. https://doi.org/10.1097/BRS.0000000000000320
Lad, Shivanand P. ; Babu, Ranjith ; Bagley, Jacob H. ; Choi, Jonathan ; Bagley, Carlos A. ; Huh, Billy K. ; Ugiliweneza, Beatrice ; Patil, Chirag G. ; Boakye, Maxwell. / Utilization of spinal cord stimulation in patients with failed back surgery syndrome. In: Spine. 2014 ; Vol. 39, No. 12.
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abstract = "STUDY DESIGN.: Retrospective analysis of a population-based insurance claims data set. OBJECTIVE.: To evaluate the use of spinal cord stimulation (SCS) and lumbar reoperation for the treatment of failed back surgery syndrome (FBSS), and examine their associated complications and health care costs. SUMMARY OF BACKGROUND DATA.: FBSS is a major source of chronic neuropathic pain and affects up to 40{\%} of patients who undergo lumbosacral spine surgery for back pain. Thus far, few economic analyses have been performed comparing the various treatments for FBSS, with these studies involving small sample sizes. In addition, the nationwide practices in the use of SCS for FBSS are unknown. METHODS.: The MarketScan data set was used to analyze patients with FBSS who underwent SCS or spinal reoperation between 2000 and 2009. Propensity score methods were used to match patients who underwent SCS with those who underwent lumbar reoperation to examine health care resource utilization. Postoperative complications were analyzed with multivariate logistic regression. Health care use was analyzed using negative binomial and general linear models. RESULTS.: The study cohort included 16,455 patients with FBSS, with 395 undergoing SCS implantation (2.4{\%}). Complication rates at 90 days were significantly lower for SCS than spinal reoperation (P < 0.0001). Also in the matched cohort, hospital stay (P < 0.0001) and associated charges (P = 0.016) were lower for patients with SCS. However outpatient, emergency room, and medication charges were similar between the 2 groups. Overall cost totaling $82,586 at 2 years was slightly higher in the lumbar reoperation group than in the SCS group with total cost of $80,669 (P = 0.88). CONCLUSION.: Although previous studies have demonstrated superior efficacy for the treatment of FBSS, SCS remains underused. Despite no significant decreases in overall health care cost with SCS implantation, because it is associated with decreased complications and improved outcomes, this technology warrants closer consideration for the management of chronic pain in patients with FBSS.",
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AU - Huh, Billy K.

AU - Ugiliweneza, Beatrice

AU - Patil, Chirag G.

AU - Boakye, Maxwell

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