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STUDY DESIGN: Economic evaluation conducted alongside a randomized controlled trial with 1-year follow-up. OBJECTIVE: To examine the cost-effectiveness of initiating rehabilitation 6 weeks after surgery as opposed to 12 weeks after surgery. SUMMARY OF BACKGROUND DATA: In a previously reported randomized controlled trial, we assessed the impact of timing of rehabilitation after a lumbar spinal fusion and found that a fast-track strategy led to poorer functional ability. Before making recommendations, it seems relevant to address the societal perspective including return to work, quality of life, and costs. METHODS: A cost-effectiveness analysis and a cost-utility analysis were conducted. Eighty-two patients undergoing instrumented lumbar spinal fusion due to degenerative disc disease or spondylolisthesis (grade I or II) were randomized to an identical protocol of 4 sessions of group-based rehabilitation and were instructed in home exercises focusing on active stability training. Outcome parameters included functional disability (Oswestry Disability Index) and quality-adjusted life years. Health care and productivity costs were estimated from national registries and reported in euros. Costs and effects were transformed into net benefit. Bootstrapping was used to estimate 95% confidence intervals (95% CI). RESULTS: The fast-track strategy tended to be costlier by 6869 (95% CI, -4640 to 18,378) while at the same time leading to significantly poorer outcomes of functional disability by -9 points (95% CI, -18 to -3) and a tendency for a reduced gain in quality-adjusted life years by -0.04 (95% CI, -0.13 to 0.01). The overall probability for the fast-track strategy being cost-effective does not reach 10% at conventional thresholds for cost-effectiveness. CONCLUSION: Initiating rehabilitation at 6 weeks as opposed to 12 weeks after surgery is on average more costly and less effective. The uncertainty of this result did not seem to be sensitive to methodological issues, and clinical managements who have already adapted fast-track rehabilitation strategies have reason to reconsider their choice.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

The article presents a study on the effect of direct current (DC) electrical stimulation on lumbar spinal fusion in patients older than 60 years. The study observed 107 patients who were randomized to posterolateral lumbar spinal fusion without and with DC-simulation, in which the fusion rates were analyzed at two year follow-up through thin slice clinical trial (CT). The study showed that 89% of patients are available for two year follow-up and DC-stimulation does not effect the fusion rate.

The article presents a study on the effect of direct current (DC) electrical stimulation in patients older than 60 years old on clinical outcome after lumbar spinal fusion. The study observed 107 patients who undergo clinical trial for the uninstrumented posterolateral lumbar spinal fusion. It cites an increase in complication after spinal fusion surgery was undertaken in older patients. Morever, DC-simulated patients are likely to have good results compared to patients without DC simulation.