Original Title: Application 1099

Authors' objectives: To evaluate the safety, effectiveness, and cost considerations associated with lumbar nonfusion posterior stabilisation devices. These are an alternative to decompression surgery or fusion surgery with/without decompression for the treatment of degenerative conditions of the spine, (primarily involving radicular pain) that have failed to respond to conservative treatment.

Authors' results and conclusions: Safety and effectiveness - The Dynesys is relatively safe and, based on a limited amount of short-term comparative evidence, appears as safe as decompression with/without fusion surgery. Limited evidence suggests that the X STOP is safe. There was no comparative information available to conclude whether the X STOP was as safe or as effective as decompression and/or fusion surgery. There was not enough evidence on the Wallis device to confidently determine whether it is as safe and effective as the comparative techniques. Preliminary results suggest that the Wallis may be as safe and as/or more effective than a discectomy alone in patients with herniated discs. These devices appear effective at providing relief of post-operative leg pain and/or preventing post-operative back pain or worsening of back pain. There are inconsistencies in the literature regarding whether non-fusion devices are as, more, or less effective than fusion and/or decompression at reducing pain, or whether they are as or more effective at improving functioning than fusion and/or decompression. It is therefore concluded that non-fusion devices with/without decompression are no worse than decompression or fusion with/without decompression. Economics - The financial incidence analysis estimated the impact on the Commonwealth Government to be between an expenditure saving of $318,072 and an increase of $36,417 per year. The additional cost to the Australian healthcare system per year is estimated to be between $40,694 and $3,673,953. The average additional cost to society per patient is $3,024 when the costs and savings are weighted according to the expected uptake of non-fusion devices. Due to the benefits of interspinous devices over conservative management, a small number of patients with mild spinal stenosis, who may not otherwise have been considered for spinal surgery, are expected to receive non-fusion surgery. The cost to the Australian Government of surgery in this population is estimated to be $886 per patient.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1099-public

Year Published: 2008

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/385CE59BD6CF6D7ACA25801000123B60/$File/1099-Assessment-Report.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)