{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T21:07:08Z","timestamp":1789160828418,"version":"build-2803163510"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,6]]},"abstract":"\n Object<\/jats:title>\n The purpose of this study was to quantify the perioperative outcomes, complications, and costs associated with posterolateral spinal fusion (PSF) among Medicare enrollees with lumbar spinal stenosis (LSS) and\/or spondylolisthesis by using a national Medicare claims database.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A 5% systematic sample of Medicare claims data (2005\u20132009) was used to identify outcomes in patients who had undergone PSF for a diagnosis of LSS and\/or spondylolisthesis. Patients eligible for study inclusion also required a minimum of 2 years of follow-up and a claim history of at least 12 months prior to surgery.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A final cohort of 1672 patients was eligible for analysis. Approximately half (50.7%) had LSS only, 10.2% had spondylolisthesis only, and 39.1% had both LSS and spondylolisthesis. The average age was 71.4 years, and the average length of stay was 4.6 days. At 3 months and 1 and 2 years postoperatively, the incidence of spine reoperation was 10.9%, 13.3%, and 16.9%, respectively, whereas readmissions for complications occurred in 11.1%, 17.5%, and 24.9% of cases, respectively. At 2 years postoperatively, 36.2% of patients had either undergone spine reoperation and\/or received an epidural injection. The average Medicare payment was $36,230 \u00b1 $17,020, $46,840 \u00b1 $31,350, and $61,610 \u00b1 $46,580 at 3 months, 1 year, and 2 years after surgery, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The data showed that 1 in 6 elderly patients treated with PSF for LSS or spondylolisthesis underwent reoperation on the spine within 2 years of surgery, and nearly 1 in 4 patients was readmitted for a surgery-related complication. These data highlight several potential areas in which improvements may be made in the effective delivery and cost of surgical care for patients with spinal stenosis and spondylolisthesis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2014.4.focus1440","type":"journal-article","created":{"date-parts":[[2014,6,1]],"date-time":"2014-06-01T03:36:17Z","timestamp":1401593777000},"page":"E5","source":"Crossref","is-referenced-by-count":58,"title":["Perioperative outcomes, complications, and costs associated with lumbar spinal fusion in older patients with spinal stenosis and spondylolisthesis"],"prefix":"10.3171","volume":"36","author":[{"given":"Kevin L.","family":"Ong","sequence":"first","affiliation":[{"name":"Exponent, Inc., Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua D.","family":"Auerbach","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Lau","sequence":"additional","affiliation":[{"name":"Exponent, Inc., Menlo Park, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordana","family":"Schmier","sequence":"additional","affiliation":[{"name":"Exponent, Inc., Alexandria, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge A.","family":"Ochoa","sequence":"additional","affiliation":[{"name":"Exponent, Inc., Menlo Park, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0360005","series-title":"Evid Based Spine Care J","first-page":"29","article-title":"Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?","volume":"1","author":"Barbanti Br\u00f2dano","year":"2010"},{"key":"b2-0360005","series-title":"PM R","first-page":"705","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"},{"key":"b3-0360005","series-title":"J Neurosurg Spine","first-page":"39","article-title":"Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. Clinical article","volume":"13","author":"Burnett","year":"2010"},{"key":"b4-0360005","series-title":"Int Orthop","first-page":"1043","article-title":"Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality","volume":"33","author":"Cheng","year":"2009"},{"key":"b5-0360005","series-title":"Eur Spine J","first-page":"321","article-title":"Functional outcome after posterolateral spinal fusion using pedicle screws: comparison between primary and salvage procedure","volume":"7","author":"Christensen","year":"1998"},{"key":"b6-0360005","series-title":"J Am Geriatr Soc","first-page":"285","article-title":"An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations","volume":"44","author":"Ciol","year":"1996"},{"key":"b7-0360005","series-title":"Bureau of Labor Statistics","article-title":"CPI Detailed Report: Data for May 2011"},{"key":"b8-0360005","series-title":"J Neurosurg Spine","first-page":"174","article-title":"Can low-grade spondylolisthesis be effectively treated by either coflex interlaminar stabilization or laminectomy and posterior spinal fusion? Two-year clinical and radiographic results from the randomized, prospective, multicenter US investigational device exemption trial. Clinical article","volume":"19","author":"Davis","year":"2013"},{"key":"b9-0360005","series-title":"Acta Orthop Belg","first-page":"578","article-title":"Posterolateral versus interbody fusion in isthmic spondylolisthesis: functional results in 52 cases with a minimum follow-up of 6 years","volume":"70","author":"Dehoux","year":"2004"},{"key":"b10-0360005","series-title":"J Clin Epidemiol","first-page":"613","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992"},{"key":"b11-0360005","series-title":"Spine (Phila Pa 1976)","first-page":"1695","article-title":"Complications after surgery for lumbar stenosis in a veteran population","volume":"38","author":"Deyo","year":"2013"},{"key":"b12-0360005","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo","year":"2010"},{"issue":"Suppl 2","key":"b13-0360005","series-title":"Surg Neurol Int","first-page":"S74","article-title":"The risks of epidural and transforaminal steroid injections in the Spine: commentary and a comprehensive review of the literature","volume":"4","author":"Epstein","year":"2013"},{"key":"b14-0360005","series-title":"Eur Spine J","first-page":"178","article-title":"Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group","volume":"12","author":"Fritzell","year":"2003"},{"key":"b15-0360005","series-title":"Spine (Phila Pa 1976)","first-page":"2521","article-title":"2001 Volvo Award Winner in Clinical Studies. Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group","volume":"26","author":"Fritzell","year":"2001"},{"key":"b16-0360005","series-title":"ISASS.org.","article-title":"Policy statement on lumbar spinal fusion surgery","author":"International Society for the Advancement of Spine Surgery (ISASS)"},{"key":"b17-0360005","series-title":"Spine (Phila Pa 1976)","first-page":"1123","article-title":"Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes","volume":"22","author":"Katz","year":"1997"},{"key":"b18-0360005","series-title":"J Bone Joint Surg Am","first-page":"e162","article-title":"Complications, reoperation rates, and health-care cost following surgical treatment of lumbar spondylolisthesis","volume":"95","author":"Lad","year":"2013"},{"key":"b19-0360005","series-title":"Acad Emerg Med","first-page":"530","article-title":"Charlson Index is associated with one-year mortality in emergency department patients with suspected infection","volume":"13","author":"Murray","year":"2006"},{"key":"b20-0360005","series-title":"J Orthop Surg","first-page":"35","article-title":"Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. 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The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study","volume":"22","author":"Thomsen","year":"1997"},{"key":"b26-0360005","series-title":"Spine J","first-page":"609","article-title":"An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis","volume":"9","author":"Watters","year":"2009"},{"key":"b27-0360005","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b28-0360005","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein","year":"2010"},{"key":"b1-0360005","series-title":"Evid Based Spine Care J","first-page":"29","article-title":"Fueling the debate: Are outcomes better after posterior lumbar interbody fusion (PLIF) or after posterolateral fusion (PLF) in adult patients with low-grade adult isthmic spondylolisthesis?","volume":"1","author":"Barbanti Br\u00f2dano","year":"2010"},{"key":"b2-0360005","series-title":"PM R","first-page":"705","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"},{"key":"b3-0360005","series-title":"J Neurosurg Spine","first-page":"39","article-title":"Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP. Clinical article","volume":"13","author":"Burnett","year":"2010"},{"key":"b4-0360005","series-title":"Int Orthop","first-page":"1043","article-title":"Posterior lumbar interbody fusion versus posterolateral fusion in spondylolisthesis: a prospective controlled study in the Han nationality","volume":"33","author":"Cheng","year":"2009"},{"key":"b5-0360005","series-title":"Eur Spine J","first-page":"321","article-title":"Functional outcome after posterolateral spinal fusion using pedicle screws: comparison between primary and salvage procedure","volume":"7","author":"Christensen","year":"1998"},{"key":"b6-0360005","series-title":"J Am Geriatr Soc","first-page":"285","article-title":"An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations","volume":"44","author":"Ciol","year":"1996"},{"key":"b7-0360005","series-title":"Bureau of Labor Statistics","article-title":"CPI Detailed Report: Data for May 2011"},{"key":"b8-0360005","series-title":"J Neurosurg Spine","first-page":"174","article-title":"Can low-grade spondylolisthesis be effectively treated by either coflex interlaminar stabilization or laminectomy and posterior spinal fusion? Two-year clinical and radiographic results from the randomized, prospective, multicenter US investigational device exemption trial. 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The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study","volume":"22","author":"Thomsen","year":"1997"},{"key":"b26-0360005","series-title":"Spine J","first-page":"609","article-title":"An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis","volume":"9","author":"Watters","year":"2009"},{"key":"b27-0360005","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b28-0360005","series-title":"Spine (Phila Pa 1976)","first-page":"1329","article-title":"Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial","volume":"35","author":"Weinstein","year":"2010"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/6\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/6\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/6\/article-pE5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:38:15Z","timestamp":1777711095000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/6\/article-pE5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,6]]},"references-count":56,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.4.focus1440","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,6]]}}}