Spine Journal - 2026-07-01 - Journal Article
Cost comparisons and perioperative outcomes in the surgical treatment of tandem spinal stenosis.
Cronin PK, Holly KE, Hatton MO, Gu AW, Cesar MD, Virani R, Schoenfeld AJ
Topics
Key Takeaway
In 174 TSS patients, posterior cervical plus lumbar fusion procedures cost 1.6× more than ACDF plus lumbar laminectomy, and posterior cervical procedures carried a 14× increased odds of surgical site infection.
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Summary
This retrospective study evaluated cost and perioperative outcomes across four procedural intensity tiers in patients undergoing staged cervical and lumbar surgery for TSS within 12 months. Adjusted generalized linear modeling showed posterior cervical plus lumbar fusion and ACDF plus lumbar fusion each cost 1.6× more than ACDF plus lumbar laminectomy (95% CI: 1.28–2.0), with proportional increases in EBL and LOS. Posterior cervical procedures were independently associated with 14× higher odds of surgical site infection (OR 14.0; 95% CI: 1.07, >999).
Key Limitation
The infection analysis is statistically unreliable due to event sparsity, with a confidence interval upper bound exceeding 999, making the 14× odds ratio uninterpretable for clinical decision-making.
Original Abstract
BACKGROUND CONTEXT
As the population ages, tandem spinal stenosis (TSS; symptomatic concomitant cervical and lumbar stenosis) can be anticipated to increase in prevalence. TSS can be challenging as it typically presents in older individuals with comorbidities and frailty.
PURPOSE
To evaluate clinical and demographic factors associated with episode costs and outcomes following treatment for cervical-lumbar TSS.
STUDY DESIGN/SETTING
Retrospective analysis.
PATIENT SAMPLE
We identified all patients who underwent an elective surgery for cervical and lumbar stenosis (2015-22). Patients were included if they underwent an elective surgery for cervical and lumbar stenosis within 12-months of each other for the clinical conditions of spinal stenosis, radiculopathy and/or spondylolisthesis. Procedures were categorized based on intensity: anterior cervical decompression and fusion and posterior lumbar laminectomy (least intense), posterior cervical procedure and lumbar laminectomy, anterior cervical decompression and fusion and lumbar decompression and fusion and posterior cervical procedure and lumbar decompression and fusion (most intense).
OUTCOME MEASURES
The primary outcome was procedural costs. Peri-operative outcomes and complications were also considered.
METHODS
Generalized linear modeling was used to determine the independent association of the procedural approach with total healthcare costs, length of stay, EBL, and OR time. Logistic regression was used to adjust for confounding associated with infection, pooled complications, 90-day readmissions, 90-day revision and 2-year revision. All analyses accounted for age, biologic sex and Charlson Comorbidity Index (CCI).
RESULTS
We identified 174 patients. In adjusted analysis, posterior cervical surgery with lumbar decompression and fusion was significantly more expensive (1.6; 95% CI: 1.28, 1.99) than anterior cervical fusion and lumbar laminectomy, as were anterior cervical with lumbar fusion (1.6; 95% CI: 1.28, 2.0) and posterior cervical procedure with lumbar laminectomy (1.3; 95% CI: 1.05, 1.60). Similar findings were encountered for blood loss and length of stay. Posterior cervical procedures and lumbar laminectomy were significantly associated with increased odds of infection (OR: 14.0; 95% CI: 1.07, >999).
CONCLUSIONS
We advocate a reliance on the least intensive surgical technique that would be expected to provide a satisfactory postoperative result. We believe that such an approach has the capacity to lower adverse events and reduce healthcare expenditures.