Surgical patients for spinal stenosis saw improvement more rapidly and reported better physical function and less pain than did the non-surgical patients, according to a multi-center, multi-state trial led by Dartmouth clinician researchers in the Spine Patient Outcomes Research Trial, or SPORT. The study also reveals that patients who choose not to have surgery are likely to improve over time as well, though they report only moderate improvement two years after their diagnosis.

The paper, published in the Feb. 21 edition of the New England Journal of Medicine, is the third in a series of study results; earlier papers reported that, for herniated disk with sciatica, surgical patients did slightly better than non-surgical patients, and that, for spondyloisthesis, surgical patients did markedly better than non-surgical patients. Future studies from the SPORT trial will examine cost-effectiveness and other measures.

"Spinal stenosis is the most common reason for lumbar spine surgery in patients over 65," says lead researcher James N. Weinstein, MD. "For the first time, we have an evidence base on which to advise our patients."

The new study followed 803 patients, 398 of whom underwent surgery. After two years, 63 percent of those who had had surgery reported major improvement in their conditions, compared with 29 percent of non-surgical patients. Both groups reported improve pain and physical function, though surgical patients self-reported in the 60-point range and non-surgical patients (who underwent treatments such as physical therapy) in the low 40s.

Lumbar laminectomy is the most common surgical treatment for spinal stenosis, but there is another option that may be even more advantageous: The X-Stop, a titanium implant made by Kyphon, decompresses the spine to alleviate leg and lower back pain.

"What's interesting about it is that it's a 15-minute outpatient procedure, compared with laminectomy, where the gold standard is about 35 to 45 minutes," says David Abraham, MD, an orthopedic surgeon with Reading Neck and Spine Center in Wyomissing, Pa. "During laminectomy, the surgeon must identify the compressed nerve and remove parts of bones and joints. But when you use the X-Stop to separate the neuroframen, you don't see nerves, you decompress the nerve indirectly. While laminectomy is safe and efficacious, this is a smaller operation."

X-Stop implants cost about $4,400 each. Depending on the state, Medicare reimburses the procedure from about $300 per level to about $1,800 per level, plus a facility fee, plus a separate carveout that covers the majority of the implant cost (Dr. Abraham notes that he uses two implants about 50 percent of the time). This compares with roughly $800 reimbursement for laminectomy.

Specialty hospitals may represent only 200 out of the 60,000 hospitals in the United States, but they are prominent in the top tier of hospitals ranked by complication and mortality rates, according to quality review firm HealthGrades. The firm reports that three of the nation's top ten cardiac programs and three of the top ten hospitals for total joint replacement surgery are specialty hospitals.

The March issue of Forbes magazine provides this report in a feature story that explores the safety of hospitals in the U.S. and discusses the development of physician-owned hospitals, and past and current adversity to their growth; there is also an accompanying sidebar describing several cases in which specialty hospitals battled targeted efforts by general hospitals to restrict specialty hospital growth..

The report offers additional kudos to specialty hospitals by highlighting a recent University of Iowa study that found complication rates in thousands of Medicare patients were 40 percent lower for hip and knee surgeries at specialty hospitals when compared to big community hospitals, and a 2006 study funded by Medicare that revealed patients are four times less likely to die after undergoing orthopedic surgery in a specialty hospital than if the procedure was performed in a full-service hospital.

The column also details the challenges facing specialty hospitals, such as ongoing hospital lobbying efforts, Medicare rules passed by Congress banning development of new specialty hospitals, and the efforts of Pete Stark (D-Calif.), the chairman of the House subcommittee that controls Medicare spending, to further limit specialty hospital business on grounds that the physicians owning specialty hospitals are receiving kickbacks from referring patients.

We are delighted to highlight the following companies in this week's E-Weekly.

Marshall Erdman & Associates. For more than 50 years, the name Marshall Erdman & Associates (Erdman) has been synonymous with the delivery of innovative healthcare facility solutions. As an integrated provider, Erdman offers service from facility conception to completion, including advance planning, development, design and construction. Headquartered in Madison, Wis., with six regional offices, Erdman has partnered with healthcare providers to deliver more than 5,000 facilities across the nation. For more information, visit www.erdman.com.

ProVation Medical. ProVation Medical has created, ProVation EHR is the first electronic health record designed for busy, cost-conscious ASCs. ProVation EHR offers robust electronic documentation and document imaging for all elements of the patient encounter, from past records to procedure documentation to follow-up care. With ProVation EHR, ASCs now have affordable access to a single, patient-centric documentation system that eliminates printing and chart storage costs, streamlines workflow and comes backed by a company ranked No.1 in KLAS for 2005, 2006 and 2007.

ProVation EHR helps your ASC by

• increasing patient throughput and streamlining workflow;
  
• eliminating patient chart storage space and costs;
  
• interfacing seamlessly with vitals monitors and information systems; and
  
• driving QI and pay-for-performance metrics

For more information e-mail Laura Gilbert or visit Provation Medical online.

McShane Construction Corporation. McShane Construction Corporation is an integrated design/build construction and real estate development firm offering comprehensive services for the healthcare industry. Established in 1984 and headquartered in Rosemont, Ill., the firm also operates regional offices in the southeast, southwest and western regions. McShane Construction's healthcare specialties include both construction and real estate services for medical office buildings, ambulatory surgery centers, specialty hospitals, critical access hospitals, diagnostic imaging centers and centers of excellence. Contact Mr. John Daly, vice president, healthcare, at 847-692-8616 or visit the firm's web site at www.mcshane.com for more information.

Ambulatory Surgery Centers of America.ASCOA (Ambulatory Surgical Centers of America) is a leader in the surgery center and surgical hospital industry, achieving exceptional quality of care and outstanding financial results. Since 1984, ASCOA's founders have helped physician-owners start and operate successful facilities -- from the initial feasibility study to accreditation and day-to-day management. ASCOA currently operates 21 facilities across the country with others in development. Physicians looking to start a new surgery center or surgical hospital venture, and existing facilites looking to improve their process and profits can find a partner in ASCOA. For more information, visit ASCOA online.