Percutaneous transforaminal endoscopic discectomy is more cost-effective than open microdiscectomy for patients with sciatica, according to a new study.
Endoscopic Vs. Open Discectomy, Which Wins?
2 min read Premium comments
Secondary#opendiscetomy#percutaneoudtransformationalendoscopicdiscectomy#sciatica
The study, “Cost-effectiveness of full endoscopic versus open discectomy for sciatica,” was first published online on February 20,2022 in the British Journal of Sports Medicine.
For their study, the research team collected economic data for both procedures and also measured effectiveness. The study was a 12-month multi-center randomized controlled trial. The study enrolled patients ranging in age from 18 to 70 years and who had been experiencing at least 6 weeks of radiating leg pain caused by lumbar disc herniation.
The multi-center and international research team measured patients’ leg pain, quality-adjusted life years (QALY) were measured and costs.
A total of 613 patients were included in the study, 304 were randomized to percutaneous transforaminal endoscopic discectomy and 309 to open microdiscectomy.
The researchers reported statistically significant differences in leg pain and QALYs in favor of percutaneous transforaminal endoscopic discectomy at 12 months follow-up (leg pain: 6.9; 95% CI 1.3 to 12.6; QALYs: 0.040; 95% CI 0.007 to 0.074).
Interestingly, the study evidence found that surgery costs were higher for percutaneous transforaminal endoscopic discectomy than for open microdiscectomy. But, noted the American and Netherland research teams, from a societal cost standpoint, all other disaggregate costs were lower for percutaneous transforaminal endoscopic discectomy than for open microdiscectomy.
Finally, the teams found that cost-effectiveness acceptability curves also supported the probability that percutaneous transforaminal endoscopic discectomy is less costly and more effective than open microdiscectomy.
The study authors include Pravesh Shankar Gadjradj, Hana M. Broulikova, Johanna M van Dongen, Sidney M. Rubinstein, Paul R. Depauw, Carmen Vleggeert, Ankie Seiger, Wilco C. Peul, Job L van Susante, Mauritis W. van Tulder, and Biswadjiet S. Harhandi.
The researchers are associated with Weill Cornell Brain and Spine Center, New York-Presbyterian/Weil Cornell Medicine New York, New York, Erasmus MC, Rotterdam, The Netherlands, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands, Leiden University Medical Center, Leiden, The Netherlands, Rijnstate, Arnhem, The Netherlands, and Aarhus University Hospital, Aarhus, Denmark.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.