Introduction: Lumbar spinal stenosis is a common cause of leg pain and difficulty walking, especially in older patients. Open laminectomy and bilateral laminotomy are the standard procedures for decompression of LSS and are very effective, although further degeneration of the spine can occur and may necessitate additional spinal surgery. Limited long-term follow-up publications exist which report on cost-effectiveness and clinical outcomes of MIS laminectomy compared to conventional open laminectomies.

Methods: We reviewed our clinical database and patient medical records for sex, age at surgery, pre-op BMI, EBL, hospital LOS, duration of surgery, post-operative complications, and patient reported Oswestry Disability Index (ODI) and Visual Analog Scales (VAS). These outcomes are reported at pre-op, 6 weeks, 6 months, and 1 year+ post-operative terms. Paired t-test and two-sample t-test with equal variances were performed to determine means, standard errors, and p-values for statistical significance.

Results: There were 116 patients in the MIS group and 13 patients in the open group. There were no significant differences in age between the 2 groups. Outcomes in the MIS group were significantly more favorable in EBL (58 v 171), direct cost ($4,903 v $9,210), and hospital LOS (1 day v. 6 days), (p values 0.0000). Compared to their preoperative scores, there was significant and sustained improvement in the ODI and VAS scores at each follow-up point for MIS patients. The outcomes in the open group were significantly improved at all follow-up points except 6 months for ODI and VAS.

Conclusions: We present a series of over 100 patients that have been treated with MIS laminectomy with excellent functional outcomes at reduced direct cost to the hospital. These findings not only prove that MIS laminectomy is clinically effective but also cost effective. Other studies have found open laminectomy to be less cost effective compared to other treatment modalities (1)

Patient Care: This study shows that minimally invasive surgery is not only a viable option for patients in terms of expected outcome improvements. It is also a cost effective option when compared against traditional, open laminectomies.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of MIS laminectomy in the treatment of lumbar spinal stenosis; 2). Discuss, in small groups cost effectiveness of MIS laminectomy compared to open laminectomy 3. Identify an effective treatment for a patient experiencing lumbar spinal pain.

References: Udeh BL1, Costandi S, Dalton JE, Ghosh R, Yousef H, Mekhail N (2014). The 2-Year Cost-Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients. Pain Pract. doi: 10.1111/papr.12160. [Epub ahead of print]