Gerstmeyer Julius, Gorbacheva Anna, Pierre Clifford, Norvell Daniel C, Heffernan Tara, Tabesh Arash, Schildhauer Thomas A, Abdul-Jabbar Amir, Oskouian Rod J, Chapman Jens R
Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Avenue, Suite 500, Seattle, WA, 98122, USA.
Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, USA.
J Orthop Surg Res. 2025 Jul 8;20(1):624. doi: 10.1186/s13018-025-06030-5.
Degenerative spondylolisthesis and spinal canal stenosis are some of the more common clinical conditions associated with low back pain, with various surgical techniques available, ranging from standalone decompression to fusion. Interspinous spacer devices (ISD) have emerged as an intermediary surgical option. The aim was to compare 90-day all-cause readmission rates between techniques, with secondary outcomes including total hospital charges and postoperative complications.
Utilizing the 2020 Nationwide Readmissions Database (NRD), adult patients (> 18 years) were selected by primary diagnosis ICD-10 code for spondylolisthesis and/or spinal stenosis. Patients were categorized by surgical treatment: ISD, decompression, or single-level posterior fusion. Treatment techniques were compared using a multivariable logistic and linear regression while adjusting for potential confounding factors. Propensity score adjustments were performed as a sensitivity analysis.
In total 37,503 patients met our inclusion criteria, with (81.2%) having received a decompression, 18.3% a fusion and 0.49% an ISD. The 90-day all-cause readmission rates were 8%, 9%, and 9% respectively (p= 0.85). ISD had the lowest mean raw hospital charges at $109,676 (p< 0.001), compared to fusion charges of $205,024. Early c omplication rates were similar across all groups, except for neurological and gastrointestinal complications.
ISD had comparable readmission and early postoperative complication rates versus decompression or fusion surgeries, with lower raw charges compared to fusion. Our results suggest that ISD may be a viable option for some patients compared to more traditional surgical techniques for spondylolisthesis or spinal stenosis. Further research into the long-term cost-effectiveness and clinical outcomes will be needed.
退行性腰椎滑脱症和椎管狭窄症是与腰痛相关的一些较为常见的临床病症，有多种手术技术可供选择，从单纯减压到融合手术。棘突间撑开装置（ISD）已成为一种中间手术选择。目的是比较不同技术之间的90天全因再入院率，次要结果包括总住院费用和术后并发症。
利用2020年全国再入院数据库（NRD），通过原发性诊断ICD-10编码选择成年患者（>18岁）患有腰椎滑脱症和/或椎管狭窄症。患者按手术治疗分类：ISD、减压或单节段后路融合。在调整潜在混杂因素的同时，使用多变量逻辑回归和线性回归比较治疗技术。进行倾向评分调整作为敏感性分析。
共有37503名患者符合我们的纳入标准，其中（81.2%）接受了减压手术，18.3%接受了融合手术，0.49%接受了ISD手术。90天全因再入院率分别为8%、9%和9%（p=0.85）。ISD的平均原始住院费用最低，为109676美元（p<0.001），而融合手术费用为205024美元。除神经和胃肠道并发症外，所有组的早期并发症发生率相似。
与减压或融合手术相比，ISD的再入院率和术后早期并发症发生率相当，与融合手术相比原始费用更低。我们的结果表明，与治疗腰椎滑脱症或椎管狭窄症的更传统手术技术相比，ISD可能是一些患者的可行选择。需要对长期成本效益和临床结果进行进一步研究。
