Posted on 01/23/2023 3:53:02 PM PST by ConservativeMind
For patients with spinal stenosis, operative treatment is associated with lower risk of death and lower costs over two years, compared with nonoperative treatment, suggests a study.
Patients with spinal stenosis experience narrowing of the spinal canal and compression of spinal nerves, causing back pain, leg pain, and other symptoms. In some patients, stenosis is related to degenerative spondylolisthesis, referring to "slipped" vertebrae often resulting from spinal degeneration.
Operative treatment of spinal stenosis can include the use of a laminectomy to decompress the spinal canal, a spinal fusion to stabilize the spine, or a combination of both. Nonoperative treatment can include use of medications, steroid injections, and physical therapy.
Spine surgery has been shown to be cost-effective in reducing pain and restoring function. Many patients experience improved quality of life and mobility following surgery.
The researchers analyzed data on 61,534 Medicare patients with spinal stenosis alone and 83,813 with stenosis and spondylolisthesis. Among these patients, 37% of those with stenosis alone and 52% of those with stenosis and spondylolisthesis were managed operatively; the most common procedures were laminectomy and spinal fusion, respectively. In both groups, the average age was about 73 years.
However, in most comparisons, the actual two-year risk of death was higher in the nonoperative group. For example, among patients with stenosis alone, mortality rates were 3.7% for nonoperative treatment versus 2.5% for laminectomy, as assessed in matched cohorts. For patients with spondylolisthesis, mortality rates were 2.3% for nonoperative treatment versus 1.3% for laminectomy and fusion. In adjusted analyses, the relative risk of death was 28% lower in operatively managed patients.
Among patients with spinal stenosis and spondylolisthesis, Medicare costs were lower with surgical treatment. For example, the average two-year costs were $47,667 for patients who underwent a laminectomy compared with $68,890 for those who were nonoperatively managed.
(Excerpt) Read more at medicalxpress.com ...
I have stenosis, it started out as just hip pain last January and by June I had lost the ability to walk ten feet, pain beyond belief. I had both a laminectomy and discectomy in August and could walk the same day - albeit not too far but made great progress once home and with physical therapy. I still feel some pain in the morning but nothing like before and some weakness but at 63 I’m glad to be up and about, walking (with a cane for longer distances). If you are not sure you need it then you probably don’t, you’ll know when you do. I don’t regret it one bit.
For me it was about being able to walk or life in a wheelchair. Glad I had the surgery.
I had both a laminectomy and discectomy and I think it was the discectomy that left me leaning a bit to the left and sore at the end of the day so I use a cane now when out and about. It keeps me standing upright and prevents a wobble. If you’re not using one you might give it a try.
I’ve thought about keeping a cane in the car, for times I know I’ll need to wait in a line, as in the Post Office.
I ‘ll need to get through the vanity of ‘not wanting to be seen using a cane’. I have to remember, nobody but me really gives a darn whether I use a cane or not. Nobody cares!
I had two stenosis surgeries. L4-L5 and then 8 years later, L3-L4. Neither required fusion, but just went in and opened up the compressed nerve canal.
I can walk, surf, but have lingering numbness and tingling in my legs and general loss of mobility. Beats the alternative, I guess, which they said was loss of lower body function, including loss of bowel and bladder control. I would rather have tingling legs than wear a diaper.
I was a candidate for lumbar fusion. The doctor said that it will need to be done for structural reasons eventually. But even then, he said the improvement of function and diminishment of symptoms would be marginal. I decided against it at this time.
CC
I'm living proof you do NOT want surgery, and that doing everything to allow the spine to heal itself naturally (therapy, responsible pain management, etc..) is the correct way.
Your doc is correct. I went through both a laminectomy and fusion three years ago with the full load-out of titanium rods and pins. I would not recommend it. IMHO the recovery time, long (and painful) Phys Therapy, and reduced range of motion really weren’t worth it for the reduction of nerve pain.
Thanks for your testimony!
Same with me CC...and they don’t discuss the cost of recovery. I get it but I’ve seen people come out of surgeries in as much pain and sometimes worse. It’s still about 50/50. I don’t like those percentages so I won’t have any surgery on my neck or back. However, thepain is intense some days.
I’m just not all that hot on recovery rates either. The costs on this do not take in to consideration of recovery times and costs.
I had the laminectomy/discectomy about 10 years ago and it did help...for about 4 years. In the end I was still forced to retire. But only slightly earlier than I was planning to. I have 2 AFO braces and can walk short distances. But cross country hiking is no longer in my repertoire.
CC
Over all has it helped with the pain or just back after those years? Some days is danged impossible for me. But I have more than stenosis also.
Age and injuries has taken its toll on me. My first loves were pro surfing and martial arts, neither of which I can do anymore.
I was forced to retire from as an RN a few years ago. That broke my heart but no way I could keep up without possibly harming patients or taking a toll on staff.
I was a cop, so standing for long periods on hard surfaces, fighting with convicts, wrestling with dudes off their meds, etc. Plus my stenosis is a congenital birth defect, not diagnosed until I was nearly 50. I do my best to stay active, but the pain is very limiting.
CC
Yep high octane job. I worked with the criminally insane. It was easier than being a cop in that we knew where the bad stuff was coming from. Except basically you had to life with them:>)
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