{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:26:23Z","timestamp":1765232783030,"version":"3.37.3"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2019,12,6]],"date-time":"2019-12-06T00:00:00Z","timestamp":1575590400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Vertiflex"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>There are several treatment options for patients suffering from lumbar spinal stenosis, including surgical and conservative care. Interspinous spacer decompression using the Superion device offers a less invasive procedure for patients who fail conservative treatment before traditional decompression surgery. This review assesses the current cost-effectiveness, safety, and performance of lumbar spinal stenosis treatment modalities compared with the Superion interspinous spacer procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>EMBASE and PubMed were searched to find studies reporting on the cost-effectiveness, safety, and performance of conservative treatment, including medicinal treatments, epidural injections, physical therapy, and alternative methods, as well as surgical treatment, including laminectomy, laminectomy with fusion, and interspinous spacer decompression. Results were supplemented with manual searches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Despite substantial costs, persistent conservative treatment (&amp;gt;12\u2009weeks) of lumbar spinal stenosis showed only minimal improvement in pain and functionality. When conservative treatment fails, surgery is more effective than continuing conservative treatment. Lumbar laminectomy with fusion has considerably greater cost than laminectomy alone, as the length of hospital stay increases, the costs for implants are substantial, and complications increase. Although laminectomy and the Superion have comparable outcomes, the Superion implant is positioned percutaneously. This approach may minimize the direct and indirect costs of outpatient rehabilitation and absenteeism, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Superion interspinous lumbar decompression is a minimally invasive procedure for patients with lumbar spinal stenosis who have failed conservative treatment. Compared with extending conservative treatment or traditional spinal surgery, interspinous lumbar decompression reduces the direct and indirect costs associated with lumbar spinal stenosis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pm\/pnz245","type":"journal-article","created":{"date-parts":[[2019,9,20]],"date-time":"2019-09-20T19:31:13Z","timestamp":1569007873000},"page":"S2-S8","source":"Crossref","is-referenced-by-count":20,"title":["Cost-effectiveness and Safety of Interspinous Process Decompression (Superion)"],"prefix":"10.1093","volume":"20","author":[{"given":"Kevin","family":"Cairns","sequence":"first","affiliation":[{"name":"Florida Spine Specialists, Nova Southeastern University, Fort Lauderdale, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"Deer","sequence":"additional","affiliation":[{"name":"The Center for Pain Relief, Spine and Nerve Centers of The Virginias, Charleston, West Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawood","family":"Sayed","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center, Kansas City, Kansas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7181-8999","authenticated-orcid":false,"given":"Kim","family":"van Noort","sequence":"additional","affiliation":[{"name":"Factory-CRO, Bilthoven, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0605-0546","authenticated-orcid":false,"given":"Kevin","family":"Liang","sequence":"additional","affiliation":[{"name":"MileStone Research Organization, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,12,6]]},"reference":[{"issue":"6","key":"2019120605231144100_pnz245-B1","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.spinee.2015.12.084","article-title":"Interspinous spacers for lumbar spinal stenosis: Commentary on van den Akker-van Marle","volume":"16","author":"Lurie","year":"2016","journal-title":"Spine J"},{"issue":"7","key":"2019120605231144100_pnz245-B2","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.spinee.2009.03.005","article-title":"Spinal stenosis prevalence and association with symptoms: The Framingham Study","volume":"9","author":"Kalichman","year":"2009","journal-title":"Spine J"},{"issue":"8","key":"2019120605231144100_pnz245-B3","doi-asserted-by":"crossref","first-page":"E469","DOI":"10.1097\/BRS.0b013e31828935ac","article-title":"Diagnosis of lumbar spinal stenosis: An updated systematic review of the accuracy of diagnostic tests","volume":"38","author":"de Schepper","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"2019120605231144100_pnz245-B4","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00586-016-4937-y","article-title":"Cost-effectiveness of conservative versus surgical treatment strategies of lumbar spinal stenosis in the Swiss setting: Analysis of the prospective multicenter Lumbar Stenosis Outcome Study (LSOS)","volume":"26","author":"Aichmair","year":"2017","journal-title":"Eur Spine J"},{"issue":"6","key":"2019120605231144100_pnz245-B5","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1097\/BRS.0000000000002849","article-title":"Long term costs of maximum non-operative treatments in patients with symptomatic lumbar stenosis or spondylolisthesis that ultimately required surgery: A five-year cost analysis","volume":"44","author":"Adogwa","year":"2019","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2019120605231144100_pnz245-B6","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/01.j.pain.0000460357.01998.f1","article-title":"Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis","volume":"156","author":"Vowles","year":"2015","journal-title":"Pain"},{"issue":"6","key":"2019120605231144100_pnz245-B7","doi-asserted-by":"crossref","first-page":"881","DOI":"10.3122\/jabfm.2018.06.180152","article-title":"Opioid overdose hospitalizations among Medicare-disability beneficiaries","volume":"31","author":"Peters","year":"2018","journal-title":"J Am Board Fam Med"},{"issue":"3","key":"2019120605231144100_pnz245-B8","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5055\/jom.2017.0384","article-title":"Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention","volume":"13","author":"Zgierska","year":"2017","journal-title":"J Opioid Manag"},{"issue":"6","key":"2019120605231144100_pnz245-B9","doi-asserted-by":"crossref","first-page":"e019491.","DOI":"10.1136\/bmjopen-2017-019491","article-title":"Opioid prescribing for chronic musculoskeletal pain in UK primary care: Results from a cohort analysis of the COPERS trial","volume":"8","author":"Ashaye","year":"2018","journal-title":"BMJ Open"},{"issue":"4","key":"2019120605231144100_pnz245-B10","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1080\/15360288.2016.1231735","article-title":"Pharmacoeconomic analysis of pain medications used to treat adult patients with chronic back pain in the United States","volume":"30","author":"Shah","year":"2016","journal-title":"J Pain Palliat Care Pharmacother"},{"issue":"2","key":"2019120605231144100_pnz245-B11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.3171\/2014.3.SPINE1320","article-title":"Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): A value analysis of cost, pain, disability, and quality of life","volume":"21","author":"Parker","year":"2014","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"2019120605231144100_pnz245-B12","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.2522\/ptj.20120379","article-title":"Physical therapy interventions for degenerative lumbar spinal stenosis: A systematic review","volume":"93","author":"Macedo","year":"2013","journal-title":"Phys Ther"},{"issue":"10","key":"2019120605231144100_pnz245-B13","doi-asserted-by":"crossref","first-page":"E609","DOI":"10.1097\/BRS.0b013e318240d57d","article-title":"Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: A systematic review","volume":"37","author":"Ammendolia","year":"2012","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"2019120605231144100_pnz245-B14","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.spinee.2017.08.254","article-title":"Patients' experience with nonsurgical treatment for lumbar spinal stenosis: A qualitative study","volume":"18","author":"Bove","year":"2018","journal-title":"Spine J"},{"issue":"4","key":"2019120605231144100_pnz245-B15","doi-asserted-by":"crossref","first-page":"879","DOI":"10.12669\/pjms.344.14349","article-title":"Exercise therapy versus surgery for lumbar spinal stenosis: A systematic review and meta-analysis","volume":"34","author":"Mo","year":"2018","journal-title":"Pak J Med Sci"},{"key":"2019120605231144100_pnz245-B16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.ijsu.2017.07.032","article-title":"Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials","volume":"44","author":"Ma","year":"2017","journal-title":"Int J Surg"},{"issue":"1","key":"2019120605231144100_pnz245-B17","doi-asserted-by":"crossref","first-page":"e23139.","DOI":"10.5812\/aapm.23139","article-title":"Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: A systematic review","volume":"5","author":"Manchikanti","year":"2015","journal-title":"Anesth Pain Med"},{"issue":"8","key":"2019120605231144100_pnz245-B18","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.pmrj.2013.05.012","article-title":"A systematic review to assess comparative effectiveness studies in epidural steroid injections for lumbar spinal stenosis and to estimate reimbursement amounts","volume":"5","author":"Bresnahan","year":"2013","journal-title":"PM R"},{"issue":"4","key":"2019120605231144100_pnz245-B19","doi-asserted-by":"crossref","first-page":"219","DOI":"10.36076\/ppj.2017.228","article-title":"Cost utility analysis of lumbar interlaminar epidural injections in the treatment of lumbar disc herniation, central spinal stenosis, and axial or discogenic low back pain","volume":"20","author":"Manchikanti","year":"2017","journal-title":"Pain Physician"},{"issue":"3","key":"2019120605231144100_pnz245-B20","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1097\/AAP.0b013e31828ea086","article-title":"Epidural steroids: A comprehensive, evidence-based review","volume":"38","author":"Cohen","year":"2013","journal-title":"Reg Anesth Pain Med"},{"issue":"18","key":"2019120605231144100_pnz245-B21","first-page":"1","article-title":"Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States","author":"Nahin","year":"2009","journal-title":"National Health Statistics Reports"},{"issue":"20","key":"2019120605231144100_pnz245-B22","doi-asserted-by":"crossref","first-page":"E1335","DOI":"10.1097\/BRS.0b013e31820c97b1","article-title":"Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: A systematic review of randomized controlled trials","volume":"36","author":"Kovacs","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019120605231144100_pnz245-B23","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1097\/BRS.0000000000000545","article-title":"Cost-effectiveness of surgical treatment for degenerative spondylolisthesis and spinal stenosis","volume":"39(22 Suppl 1)","author":"Harrop","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"issue":"13","key":"2019120605231144100_pnz245-B24","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010","journal-title":"JAMA"},{"key":"2019120605231144100_pnz245-B25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3171\/2010.3.SPINE09552","article-title":"Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: Nonsurgical care, laminectomy, and X-STOP","volume":"13","author":"Burnett","year":"2010","journal-title":"J Neurosurg Spine"},{"issue":"2","key":"2019120605231144100_pnz245-B26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jos.2017.11.014","article-title":"Cost-effectiveness of posterior lumbar interbody fusion in the Japanese universal health insurance system","volume":"23","author":"Fujimori","year":"2018","journal-title":"J Orthop Sci"},{"issue":"7","key":"2019120605231144100_pnz245-B27","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/BRS.0b013e31828628f5","article-title":"Readmission rates after decompression surgery in patients with lumbar spinal stenosis among Medicare beneficiaries","volume":"38","author":"Modhia","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"2019120605231144100_pnz245-B28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.3171\/2011.9.SPINE11308","article-title":"Cost per quality-adjusted life year gained of revision neural decompression and instrumented fusion for same-level recurrent lumbar stenosis: Defining the value of surgical intervention","volume":"16","author":"Adogwa","year":"2012","journal-title":"J Neurosurg Spine"},{"issue":"5","key":"2019120605231144100_pnz245-B29","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1007\/s00586-012-2479-5","article-title":"Long-term health care utilisation and costs after spinal fusion in elderly patients","volume":"22","author":"Andersen","year":"2013","journal-title":"Eur Spine J"},{"issue":"1","key":"2019120605231144100_pnz245-B30","doi-asserted-by":"crossref","first-page":"221.","DOI":"10.1186\/1471-2474-15-221","article-title":"Two-year clinical outcomes of a multicenter randomized controlled trial comparing two interspinous spacers for treatment of moderate lumbar spinal stenosis","volume":"15","author":"Patel","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"2019120605231144100_pnz245-B31","first-page":"823509","article-title":"Interspinous spacer implant in patients with lumbar spinal stenosis: Preliminary results of a multicenter, randomized, controlled trial","volume":"2012","author":"Miller","year":"2012","journal-title":"Pain Res Treat"},{"issue":"8","key":"2019120605231144100_pnz245-B32","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/BRS.0000000000000798","article-title":"Comparing cost-effectiveness of X-Stop with minimally invasive decompression in lumbar spinal stenosis: A randomized controlled trial","volume":"40","author":"Lonne","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"key":"2019120605231144100_pnz245-B33","doi-asserted-by":"crossref","first-page":"975052","DOI":"10.1155\/2014\/975052","article-title":"Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: Past, present, and future","volume":"2014","author":"Gazzeri","year":"2014","journal-title":"Biomed Res Int"},{"issue":"5","key":"2019120605231144100_pnz245-B34","doi-asserted-by":"crossref","first-page":"E345","DOI":"10.1097\/BRS.0b013e3181f2ed2f","article-title":"Cost-effectiveness of the X-STOP(R) interspinous spacer for lumbar spinal stenosis","volume":"36","author":"Skidmore","year":"2011","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"2019120605231144100_pnz245-B35","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s12178-017-9413-8","article-title":"Interspinous implants to treat spinal stenosis","volume":"10","author":"Gala","year":"2017","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"6","key":"2019120605231144100_pnz245-B36","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1586\/17434440.2015.1100071","article-title":"Stand-alone interspinous spacer versus decompressive laminectomy for treatment of lumbar spinal stenosis","volume":"12","author":"Lauryssen","year":"2015","journal-title":"Expert Rev Med Devices"},{"issue":"4","key":"2019120605231144100_pnz245-B37","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1586\/erd.11.24","article-title":"Rationale, design and clinical performance of the Superion\u00ae interspinous spacer: A minimally invasive implant for treatment of lumbar spinal stenosis","volume":"8","author":"Loguidice","year":"2011","journal-title":"Expert Rev Med Devices"},{"key":"2019120605231144100_pnz245-B38","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.2147\/CIA.S143503","article-title":"Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis","volume":"12","author":"Nunley","year":"2017","journal-title":"Clin Interv Aging"},{"key":"2019120605231144100_pnz245-B39","doi-asserted-by":"crossref","first-page":"28.","DOI":"10.14444\/2028","article-title":"Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer","volume":"9","author":"Parker","year":"2015","journal-title":"Int J Spine Surg"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/20\/Supplement_2\/S2\/31236118\/pnz245.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/painmedicine\/article-pdf\/20\/Supplement_2\/S2\/31236118\/pnz245.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T05:32:05Z","timestamp":1664429525000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/20\/Supplement_2\/S2\/5661168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,1]]},"references-count":39,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2019,12,6]]},"published-print":{"date-parts":[[2019,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnz245","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"type":"print","value":"1526-2375"},{"type":"electronic","value":"1526-4637"}],"subject":[],"published-other":{"date-parts":[[2019,12]]},"published":{"date-parts":[[2019,12,1]]}}}