3/22/2023 0 Comments Mildprocedure com more info![]() ![]() The latter may lead to steroid-related complications as osteoporosis, worsening of diabetes, or hypertension, as well as increased cost over the long term.įor LSS sufferers, who have failed conservative therapy or received minimal benefit from serial epidural steroid injections, or who are not candidates for surgery, another option exists. This leaves these patients untreated or continuing to receive short-term relief with repeated ESI. Lastly, there are a considerable number of elderly patients, based on their degree of symptoms or disability, who have failed conservative therapy and either refuse surgery or considered “high risk” of surgery. ![]() However, it is much more costly, an option only for moderate or severe symptom sufferers, and is associated with a considerably higher rate of complications, which increase the cost of care. Surgical decompression on the other hand, if successful, can be 1-time intervention. Treatment, however, must be repeated frequently as its effect is time limited. Conservative treatment on 1 end is the least costly and often successful for early stages of LSS or in patients with minimal symptoms. Furthermore, these treatments vary great in cost. Treatments have varying degrees of success, due to symptom levels, severity of the stenosis, the presence or the absence of neurologic deficits, the associated comorbidities as well the time of intervention in relation to the progress of the disease process. Treatments for LSS range from conservative management, such as medications, physical therapy with or without epidural steroid injections (ESI) to major surgical decompression of the lumbar spine with or without fusion/instrumentation. 1 These limitations can have great physical, psychological, and financial negative impact on the individual patient and more importantly on the healthcare system and on the society as a whole. Pain and physical limitations result in significant decrease in the quality of life. 1, 2 LSS patients experience pain with any excessive walking or standing, leading to serious physical limitation. The degenerative changes may manifest as disk bulge, which compromise the size of spinal canal anteriorly, hypertrophy and buckling of the ligamentum flavum, which encroach on the size of the spinal canal posteriorly and by hypertrophy of the lumbar facet joints, which compromise the lateral recesses of the spinal canal. Lumbar spinal stenosis (LSS) often results from age related degenerative changes in the lumbar spine. Laminectomy surgery was the least cost-effective ($125,985/QALY). The mild ® strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild ® to ESI or laminectomy surgery. ![]() Minimally invasive lumbar decompression ( mild ®) is an alternative. Laminectomy surgery is more costly and has higher complication rates. ![]() ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Treatments vary greatly in cost and success. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. ![]()
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