Cauda Equina Syndrome: Cost Burden After Spinal Decompression

Darren Z Nin; Ya-Wen Chen; Raymond W Hwang; Ruijia Niu; Nathan J Sinz; David C Chang; David H Kim

doi:10.5435/JAAOS-D-23-01215

Cauda Equina Syndrome: Cost Burden After Spinal Decompression

J Am Acad Orthop Surg. 2024 May 14. doi: 10.5435/JAAOS-D-23-01215. Online ahead of print.

Authors

Darren Z Nin¹, Ya-Wen Chen, Raymond W Hwang, Ruijia Niu, Nathan J Sinz, David C Chang, David H Kim

Affiliation

¹ From the Department of Orthopedic Surgery, New England Baptist Hospital (Nin, Hwang, Niu, Chang, and Kim), the Department of Surgery, Massachusetts General Hospital, Harvard Medical School (Nin, Chen, and Chang), Tufts University School of Medicine (Hwang and Kim), and the Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA (Sinz).

PMID: 38748906
DOI: 10.5435/JAAOS-D-23-01215

Abstract

Study design: Observational cohort study.

Objective: Cauda equina syndrome (CES) is a rare neurologic condition with potentially devastating consequences. The objective of this study was to compare the 2-year postoperative cost-associated treatments after posterior spinal decompression between patients with and without CES.

Methods: By analyzing a commercial insurance claims database, patients who underwent posterior spinal decompression with a concurrent diagnosis of lumbar spinal stenosis, radiculopathy, or disk herniation in 2017 were identified and included in the study. The primary outcome was the cost of payments for identified treatments in the 2-year period after surgery. Treatments included were (1) physical therapy (PT), (2) pain medication, (3) injections, (4) bladder management, (5) bowel management, (6) sexual dysfunction treatment, and (7) psychological treatment.

Results: In total, 3,140 patients (age, 55.3 ± 12.0 years; male, 62.2%) were included in the study. The average total cost of treatments identified was $2,996 ± 6,368 per patient. The overall cost of identified procedures was $2,969 ± 6,356 in non-CES patients, compared with $4,535 ± 6,898 in patients with CES (P = 0.079). Among identified treatments, only PT and bladder management costs were significantly higher for patients with CES (PT: +115%, P < 0.001; bladder management: +697%, P < 0.001). The difference in overall cost was significant between patients (non-CES: $1,824 ± 3,667; CES: $3,022 ± 4,679; P = 0.020) in the first year. No difference was found in the second year.

Discussion: A short-term difference was observed in costs occurring in the first postoperative year. Cost of treatments was similar between patients apart from PT and bladder management.