Introduction: Post-laminectomy pain syndrome (aka Failed back surgery syndrome or FBSS) represents a major source of chronic neuropathic pain. Several landmark studies in the field have demonstrated superior pain relief, improved quality of life, and functional capacity following treatment with spinal cord stimulation (SCS) compared to spinal re-operation. The goal of this study was to determine the real world utilization of SCS in this population and compare complications, charges and healthcare resources in a large, independent cohort of FBSS patients undergoing surgical intervention.
Methods: The Reuter’s MarketScan database was utilized to perform a retrospective, cross-sectional, population-based study. FBSS patients who underwent SCS or spinal reoperation (laminectomy, fusion, revision fusion) between 2000 and 2009 were identified. Logistic regression analysis was used to examine long-term complication rates. Propensity score matching was utilized to compare a matched cohort of patients, examining hospital charges and healthcare resource utilization.
Results: The study cohort comprised a total of 16,455 FBSS patients, with a total of 395 patients undergoing SCS implantation (2.4%) and the remaining 16,060 undergoing spinal re-operation (97.6%). Complication rates at 90 days were significantly lower for SCS compared to spinal re-operation (6.5% vs. 14.4%, p<0.0001). In a matched cohort of patients, hospital charges were lower for SCS compared to spinal re-operation ($31,210 vs. $40,433, p=0.02). However outpatient, emergency room, and medication charges were not significantly different between the two groups.
Conclusions: Despite prior data suggesting improved functional outcomes, lower complications, and hospital charges with SCS compared to spinal re-operation, only a small percentage of FBSS patients currently receive SCS.
Patient Care: Technological advancements in the field of neurosurgery have improved our ability to treat and manage a variety of conditions. However, it frequently requires a significant amount of time for a shift in the standard of care to occur. Though many studies have shown spinal cord stimulation to be superior to spinal re-operation, we show that a very small number of patients with failed back surgery syndrome undergo SCS implantation. Additionally, we demonstrate significantly lower complication rates in those undergoing SCS implantation. Therefore it is imperative that the neurosurgical community consider the use of SCS for the treatment of FBSS prior to performing a spinal re-operation. Also in the current economic climate, it is increasingly important to identify the most cost-effective treatments. We show that SCS is associated with significantly decreased hospital costs compared to spinal re-operation, further supporting the increased use of this technology. We hope this study illuminates the underuse of SCS in the treatment of FBSS and increases awareness of the efficacy, safety, and cost-effectiveness of this treatment modality.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the treatment of FBSS, 2) Discuss, in small groups the various treatment options and their relative efficacy in the treatment of FBSS, 3) Identify an effective treatment for FBSS which is both efficacious, but also low in cost and patient risk.