ISP Offered More In High Income Areas And Inpatient Hospital Use Decreasing

Interspinous fixation (ISP) devices are designed to be less invasive and require less exposure of the spinal anatomy for implantation versus pedicle screws and interbodies. A recent study showed a 73% decline in hospital use of ISP between 2008 and 2014. Interestingly the length of stay was increasing during that time to suggest sicker patients were being treated at the same time that the inpatient use of ISP was declining. Another interesting finding was that geographic use was more prevalent in high-income areas versus low-income. We took this to conclude that higher income patients were less likely to choose more invasive surgeries like pedicle screws or laminectomies while poor income patients were probably not given the same education or choices in selecting an ISP. Although there is no hard evidence for this, we see this trend with high-income patients who come to the surgeon already researched the surgeon, the diagnosis and the different treatment options compared to poorer patients who tend to have less formal education. Today we see increasing use of ISP in outpatient ambulatory surgery centers for treating spinal stenosis and spinal fusions. This trend continues despite headwinds from insurance companies often reluctant to reimburse ISP devices over pedicle screws. Another headwind is the fear from orthopedic spine surgeons and neurosurgeons that pain management doctors will do more spinal stenosis treatments and spinal fusions using ISP devices. There are others who are starting to embrace outpatient ambulatory surgery centers and thus are relooking at ISP. These surgeons are starting to return to ISP devices with stable biomechanical characteristics, clinical track record, low device-related failures, and appropriate FDA clearance such as Inspan. The reimbursement for an ISP device is greater than $10,000 for the facility fee in a Medicare facility and takes less than an hour to perforin with high safety profile. Patients do very well from preservation of their anatomy and little blood loss or tissue disruption. We predict the trend of less ISP in hospitals will continue as more spine surgeries move to outpatient ambulatory surgery centers. More pain management doctors will be using ISP devices to treat patients who will choose to avoid pedicle screws and interbodies, so the higher income areas and higher educated patients will likely lead the trend to ISP.

Reference

Utilization of Interspinous Devices Throughout the United States Over a Recent Decade: An Analysis of the Nationwide Inpatient Sample

https://pubmed.ncbi.nlm.nih.gov/29977724/

Authors

Dr. Kingsley R. Chin MBA is a board-certified Professor of Orthopedic Spine Surgery and honors graduate of Harvard Medical School and the Harvard Combined Orthopedic Residency Program. He did his spine fellowship with Dr. Henry H Bohlman. He was Chief of Spine Surgery at the University of Pennsylvania.

Dr. Jason A. Seale MBA is a medical doctor and entrepreneur. He is the clinical director at the LES Clinic.