1422. Regional and Insurance Payer-Based Differences in the use of Spinal Cord Stimulation to treat Post-Laminectomy Syndrome

Authors: Robert Wagner Bina, MD; Robert Bina, MD; Martin Weinand, MD; Anand Rughani, MD; G Lemole, MD; Travis Dumont, MD (Tucson, AZ)

Introduction: Failed back post-laminectomy pain syndrome is an expansive diagnosis incorporating a wide variety of pathologies with a wide variety of treatments, which are known to vary by region, population density, hospital type, and insurance payer.  The use of spinal cord stimulation (SCS) to treat this syndrome has documented clinical efficacy.  This study was conducted under the hypothesis that there are payer dependent disparities in the use of SCS to treat lumbar post-laminectomy syndrome; also, there are regional and hospital type utilization differences use of SCS. 

Methods: The National Inpatient Sample (NIS) was queried for admissions with a primary diagnosis of lumbar post-laminectomy syndrome.  Treatments were then compared with Chi-square analysis based on primary insurer, hospital type, and region.  Total charges were also compared.  

Results: 6,192 patients were extracted from the NIS with the indicated diagnosis: 69% underwent fusion and 7% underwent SCS. SCS implantation rate was 6% for private payers and 10% for Medicare/Medicaid. For SCS, 52% had Medicare/Medicaid, 30% had private insurers (c2=27; p<0.0001).  For regional analysis, 6,202 patients were available.  SCS implantation rate was 14% was in the Northeast and 6% in the South. Fusion was most used in the South (74%) (c2=158; P<0.0001). Fusion median charge was $83,022; mean $107,952.  SCS median charge was $80,741; mean $86,768.

Conclusion:  Findings indicate that the utilization of spinal cord stimulation varies by payer. There are regional and hospital-dependent variations in the utilization of SCS to treat post-laminectomy syndrome.