The ultimate goal of biomedical research is to improve patients outcomes; we strive to improve the quality of life for patients suffering from neurological diseases or disorders. Evidence-Based Medicine researchers work in collaboration with NeuroTexas Institute Quality Program to qualify and quantify evidence-based practices as a means to improve patient care and outcomes, while decreasing healthcare costs. By assessing the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic testing, researchers can apply scientific method to establish treatment regimen efficacy and cost effectiveness.
Spine Surgery Outcomes
Our researchers are using mathematical models to understand the costs and benefits of spine surgery versus prolonged non-surgical care for treatment of herniated lumbar disks. The aim of these efforts is to better understand when it’s advantageous to remain on conservative care, and when surgical care will offer the most benefit to patients. This study may greatly reduce the impact on the everyday lives of patients undergoing treatment for common problems such as herniated vertebral discs or sciatica.
Our scientists are working with researchers at the renowned Barrow Neurological Institute to understand how, when and why dysphagia (difficulty swallowing) arises following cervical spine surgery. This project seeks to identify the primary determinants that increase the frequency of dysphagia, with the hope that new understanding will pave the way for reducing the already low incidence of swallowing problems.
Publications
Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. Burnett, MG, Stein, SC, Bartels, RH. Journal of Neurosurgery Spine. (2010) Jul; 13(1), 36-8.
Abstract
OBJECT Standard treatment options for patients with lumbar spinal stenosis include nonoperative therapies as well as decompressive laminectomy. The introduction of interspinous decompression devices such as the X-STOP has broadened treatment options, but data comparing these treatment strategies are lacking. The object of this study was to provide a cost-effectiveness analysis of laminectomy, interspinous decompression, and nonoperative treatment for patients with lumbar stenosis. METHODS The authors performed a structured literature review of lumbar stenosis and constructed a cost-effectiveness model. Using conservative treatment, decompressive laminectomy, and placement of X-STOP as the treatment arms, their primary analysis evaluated the optimal treatment strategy for a patient with lumbar stenosis at a 2-year time horizon. Secondary analyses were done to compare cases in which patients required single-level procedures with those in which multilevel procedures were required as well as to examine the outcomes for a 4-year time horizon. Outcomes were calculated using quality-adjusted life years and costs were considered from the perspective of society. RESULTS Laminectomy was found to be the most effective treatment strategy, followed by X-STOP and then conservative treatment at a 2-year time horizon. Both surgical procedures were more costly than conservative treatment. Because laminectomy was both more effective and less costly than X-STOP, it is said to dominate overall. When single level procedures were considered alone, laminectomy was more effective but also more costly than X-STOP.
CONCLUSIONS Lumbar laminectomy appears to be the most cost-effective treatment strategy for patients with symptomatic lumbar spinal stenosis.
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