Turkish Neurosurgery
A Cost-Effectiveness Analysis of Bilateral Decompression via Unilateral Approach versus Instrumented Total Laminectomy and Fusion for Lumbar Spinal Stenosis
Ali Erhan Kayalar1, Mehmet Resid Onen1, Aydin Gerilmez2, Sait Naderi1
1 University of Health Sciences, Umraniye Teaching Hospital, Neurosurgery, Istanbul,
2University of Health Sciences, Haydarpaşa Numune Teaching Hospital, Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.24318-18.1

Aim:Minimally invasive procedures such as microsurgical or endoscopic decompression, and bilateral decompression via unilateral approach have been popularized during the recent years in the treatment of lumbar spinal stenosis. The aim of this study was to compare the clinical and economical results of two different surgical approaches (bilateral decompression via unilateral approach versus instrumented total laminectomy and fusion) in the treatment of lumbar spinal stenosis. Material and Methods:Clinical, surgical and economical aspects of 100 operated patients with lumbar spinal stenosis were reviewed retrospectively. Results:Decompression was applied at 158 levels of 100 cases. The most common levels where decompression was applied were L4-5 and L3-4, respectively. The difference betweeen preoperative and postoperative VAS scores was determined to be statistically significant in both groups (p<0.05). In Group 1, the mean surgery cost was 2.539,2 USD (mean procedure cost 1440,1 USD, and the mean implant cost 1099,2 USD), and 998,5 USD, in non-instrumented group (bilateral decompression via unilateral approach group), respectively (p<0.05).Conclusion:This study revealed similar clinical results after two different surgical perocedures with and without stabilization in cases with lumbar spinal stenosis. However, the cost of surgery was found to be 2.5 fold higher in instrumented decompression group, when compared to bilateral decompression via unilateral approach. In conclusion, this study supported the concept of cost-effectiveness of minimally invasive spine surgery.

Corresponding author : Ali Erhan Kayalar