Introduction: Post laminectomy pain syndrome is a perplexing and challenging complaint common in a neurosurgical spine practice. There are a multitude of treatment options for the treatment of this syndrome – fusion, neuromodulation, intrathecal analgesia, revision laminectomy, and other pain treatment strategies. In an effort to understand differences in treatment, a large multi-payer database (National Inpatient Sample, NIS) was queried to assess different approaches to treatment utilization differences for lumbar post-laminectomy syndrome.
Methods: NIS was queried for years 2008-2012 for elective admissions with primary diagnosis code 722.80 (lumbar postlaminectomy syndrome). Cases were compared for primary surgical interventions including spinal fusion, spinal cord stimulator, pain pump implantation, laminectomy or microdiskectomy, or no surgery. Treatment options were compared based on regional factors, hospital factors, and patient factors. Hospital charges were compared for different treatment strategies. All statistics were performed with SAS and compared with Chi-square statistics or ANOVA where appropriate.
Results: There were 6189 patients registered in the NIS for the postlaminectomy syndrome. Treatments varied with 69% of patients undergoing fusion, 7% with spinal cord stimulator (SCS) implant (n=435), 3% with intrathecal analgesia, 2% with laminectomy, and 18% with no surgical intervention. Fusion surgery was more common in Southern states and in patients with private insurance. SCS was more common in Northeastern states and in patients with Medicare/Medicaid.
Conclusions: These data demonstrate regional and socioeconomic differences in the implantation of SCS as a treatment for post-laminectomy syndrome. This is relevant given disparate hospital charges and treatment outcomes for the different procedures.
Patient Care: Through the identification of disparities and regional utilization differences, the surgical treatment of post-laminectomy syndrome can be better studied. This will allow for trials of treatment paradigms for direct comparison, which will ultimately lead to improving treatment for this difficult syndrome.
Learning Objectives: After this session, participants will …
Identify socioeconomic disparities in the surgical treatment of post-laminectomy syndrome
Know regional and population dependent variability in the surgical treatment of post-laminectomy syndrome
Identify possible underlying causes for the socioeconomic and regional variation in the treatment of post-laminectomy syndrome