Spinal stenosis is a narrowing of one or more areas of the spine which can put pressure on the spinalcord or spinal nerves. Depending on which nerves are affected, spinal stenosis can cause pain, numbness, loss of sensation, or problems with bowel or bladder function. In recent decades, surgery for older patients with spinal stenosis has become increasingly common and there are many different options for surgical intervention. In the April 7 issue of the Journal of the American Medical Association,investigators report that complex, invasive spinal fusion procedures are becoming more common.
There is a general lack of consensus on specific surgical procedures for relieving the pain associated with spinal stenosis. So, individual surgeon preferences may strongly influence the decision-making process and these choices are important because more invasive spinal procedures are associated with a higher rate of complications, health care use, and mortality, without a significant difference in clinical benefit. Researchers from Oregon Health and Science University examined the trends in the use of different types of spinal stenosis operations, as well as the association of complications and health care use with surgical complexity. They studied 32,152 Medicare patients who underwent surgery for lumbar spinal stenosis and found that, although overall surgical rates declined, the rate of complex fusion procedures increased by 15 times. As would be expected, life-threatening complications increased with the level of surgical invasiveness. People who underwent complex fusion procedures for spinal stenosis were three times more likely to suffer life-threatening complications than those who underwent decompression procedures. And, the hospital charges for complex fusion procedures were more than triple that of decompression procedures.
Spinal stenosis is common among older adults, in part due to age-related changes in the spine. The risks of spinal surgery are particularly important among this population of patients, as they are more likely to have co-morbid conditions which can influence surgical outcomes. The authors suggest that better information on surgical complications might help surgeons, referring physicians, and people with spinal stenosis to more accurately weigh the risks and benefits of different types of surgery for pain relief.