Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
World Neurosurg. 2024 May;185:417-434.e3. doi: 10.1016/j.wneu.2024.03.054. Epub 2024 Mar 19.
Interspinous devices (ISDs) and interlaminar devices (ILDs) are marketed as alternatives to conventional surgery for degenerative lumbar conditions; comparisons with decompression alone are limited. The present study reviews the extant literature comparing the cost and effectiveness of ISDs/ILDs with decompression alone.
Articles comparing decompression alone with ISD/ILD were identified; outcomes of interest included general and disease-specific patient-reported outcomes, perioperative complications, and total treatment costs. Outcomes were analyzed at <6 weeks, 3 months, 6 months, 1 year, 2 years, and last follow-up. Analyses were performed using random effects modeling.
Twenty-nine studies were included in the final analysis. ILD/ISD showed greater leg pain improvement at 3 months (mean difference, -1.43; 95% confidence interval, [-1.78, -1.07]; P < 0.001), 6 months (-0.89; [-1.55, -0.24]; P = 0.008), and 12 months (-0.97; [-1.25, -0.68]; P < 0.001), but not 2 years (P = 0.22) or last follow-up (P = 0.09). Back pain improvement was better after ISD/ILD only at 1 year (-0.87; [-1.62, -0.13]; P = 0.02). Short-Form 36 physical component scores or Zurich Claudication Questionnaire (ZCQ) symptom severity scores did not differ between the groups. ZCQ physical function scores improved more after decompression alone at 6 months (0.35; [0.07, 0.63]; P = 0.01) and 12 months (0.23; [0.00, 0.46]; P = 0.05). Oswestry Disability Index and EuroQoL 5 dimensions scores favored ILD/ISD at all time points except 6 months (P = 0.07). Reoperations (odds ratio, 1.75; [1.23, 2.48]; P = 0.002) and total care costs (standardized mean difference, 1.19; [0.62, 1.77]; P < 0.001) were higher in the ILD/ISD group; complications did not differ significantly between the groups (P = 0.41).
Patient-reported outcomes are similar after decompression alone and ILD/ISD; the observed differences do not reach accepted minimum clinically important difference thresholds. ISD/ILDs have higher associated costs and reoperation rates, suggesting current evidence does not support ILD/ISDs as a cost-effective alternative to decompression alone.
棘突间装置（ISD）和椎板间装置（ILD）作为退行性腰椎疾病的传统手术替代方法而上市；与单纯减压相比，其比较有限。本研究回顾了现有文献，比较了 ISD/ILD 与单纯减压的成本和效果。
确定了比较单纯减压与 ISD/ILD 的文章；感兴趣的结果包括一般和疾病特异性患者报告的结果、围手术期并发症和总治疗费用。在<6 周、3 个月、6 个月、1 年、2 年和最后一次随访时分析结果。使用随机效应模型进行分析。
最终分析纳入了 29 项研究。ILD/ISD 在 3 个月（平均差异，-1.43；95%置信区间，[-1.78，-1.07]；P<0.001）、6 个月（-0.89；[-1.55，-0.24]；P=0.008）和 12 个月（-0.97；[-1.25，-0.68]；P<0.001）时改善腿部疼痛的效果更好，但在 2 年（P=0.22）或最后一次随访（P=0.09）时没有改善。只有在 1 年时，ISD/ILD 后背部疼痛改善更好（-0.87；[-1.62，-0.13]；P=0.02）。短期 36 项健康调查简表或苏黎世跛行问卷（ZCQ）症状严重程度评分在两组之间没有差异。ZCQ 躯体功能评分在单纯减压后 6 个月（0.35；[0.07，0.63]；P=0.01）和 12 个月（0.23；[0.00，0.46]；P=0.05）时改善更明显。在所有时间点，Oswestry 残疾指数和 EuroQoL 5 维度评分均有利于 ILD/ISD，除 6 个月外（P=0.07）。ILD/ISD 组再手术（优势比，1.75；[1.23，2.48]；P=0.002）和总医疗费用（标准化均数差，1.19；[0.62，1.77]；P<0.001）更高；两组并发症无显著差异（P=0.41）。
单独减压和 ILD/ISD 后患者报告的结果相似；观察到的差异未达到公认的最小临床重要差异阈值。ISD/ILD 具有更高的相关成本和再手术率，表明当前证据并不支持 ILD/ISD 作为单纯减压的一种具有成本效益的替代方法。
