A COMPARISON OF COST AND OUTCOME AT ONE YEAR BETWEEN INTRADISCAL ELECTROTHERMAL THERAPY AND FUSION OF A SINGLE LEVEL IN THE LUMBAR SPINE.

Abstract

Purpose of study. To compare the cost and outcome of Intradiscal Elecrothermal Therapy (IDET) with fusion (anterior lumbar interbody fusion with posterior translaminar screws) at one year, in single level lumbar disc disease.

Methods. 49 patients were prospectively enrolled for IDET. The 49 fusion group patients had either a Syncage or Femoral Ring Allograft. All patients had at least 6 months of LBP with single level disease on MRI or positive discography.

Results. The two groups were demographically similar. Pre-treatment ODI, VAS and SF-36 for physical function were significantly worse in the fusion group (p< 0.05). At 1 year, IDET patients had clinically important improvement in ODI (47 to 37, p< 0.001), SF-36 pain (26 to 42, p< 0.001) and physical function (40 to 54, p< 0.001), with a significant drop in VAS (5.4 to 4.2, p=0.012). Fusion patients had clinically important improvement in ODI (54 to 44, p< 0.001) and SF-36 pain (25 to 37, p< 0.001) but not in physical function (32 to 39, p=0.08), with a significant improvement in VAS (7.2 to 5.7, p=0.001). Within 1 year, 11 patients in the IDET group had further interventions (4 nerve root blocks, 1 fusion, 2 disc replacements, 2 posterior interbody fusions) and 9 further procedures were carried out in the fusion group (2 epidurals, 1 facet injection, 4 wound washouts, 1 revision posterior instrumentation, 1 repair pseudomeningocoele). Cost per patient at 1year, including all secondary procedures, was £7,545 for fusion and £2,851 for IDET patients.

Conclusions. Fusion is substantially more expensive than IDET with comparable clinical outcome.