Back pain affects more than 80% of people in the U.S. at a cost of more than $100 billion a year. While many conditions can be treated conservatively (non-surgically), sometimes surgery is the only way to provide considerable relief. The question becomes whether or not the high cost of spine surgery is worth it.

A recent study conducted at Rush University Medical Center in Chicago suggests that for patients with spinal stenosis, a laminectomy, or surgical removal of pain-causing soft bone and tissue, is a reasonable value. However, for patients with spinal stenosis who have associated slipped vertebrae, the benefits of spinal fusion surgery may not be worth the costs.

Rush was one of 13 sites across the country that followed patients in this Spine Patient Outcomes Research Trial (SPORT). This study is significant, as it is the first to systematically track health care expenditures along with health outcomes. With more than 650,000 spinal surgical procedures being formed annually in the U.S. at costs exceeding $20 billion, the value of this investment is an important consideration.

The study consisted of 3,900 patients with one of two conditions: spinal stenosis treated with laminectomy, and spinal stenosis with associated slipped vertebrae, treated with spine fusion surgery. The patients were divided into groups of non-surgical vs. surgical treatments; of the surgical patients, 320 underwent laminectomy and 344 had spinal fusion.


Researchers used the Quality Adjusted Life Year (QALY) scale to perform a cost/benefit analysis over a two-year post-surgery period. Laminectomy was calculated to cost $77,000 per QALY gained, while spinal fusion surgery was estimated to be $115,000 per QALY gained. In the United States, $100,000 is the maximum at which procedures are considered cost effective.

While the initial analysis indicates that laminectomy offers better value than spine fusion surgery, a definitive assessment of long-term cost effectiveness is still in the works. Cost effectiveness is an important consideration in providing patients with quality care, but the bottom line is that for many patients suffering from back pain, relief is worth any cost.

The study is published in the December 16 issue of the Annals of Internal Medicine.


Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 Years