Moderator: Raja Y. Rampersaud, MD, FRCSC
Lumbar spinal stenosis (LSS) is a common degenerative condition that leads to significant pain, disability, work loss, reduced health-related quality of life (HRQoL) and an annual economic burden estimated in the billions of dollars. Degenerative lumbar spondylolisthesis (DLS) is a common subgroup of LSS with an estimated prevalence of 6% of the adult population that increases from the 5th to 8th decade of life. With the aging population, the future health resource demands for the DLS population will be significant. In the current health resource environment, meaningfully and comparative effectiveness research (CER) are paramount to enable advocacy for this growing demographic. The current medical paradigm dictates a step-wise approach starting with self-management, allied health interventions, pain interventions, and eventually surgical interventions or those who have failed everything else. However, while this approach makes perfect sense for patients likely to respond to conservative intervention, it may delay effective ‘downstream’ care to those who are high risk of failure of a particular ‘upstream’ intervention and thus can lead to poorer outcomes and ultimately higher cost.
This symposium presents both a pragmatic and best evidence approach to the continuum of care for DLS. Opinion leaders from across the continuum of care will provide evidence to identify the ideal patient for different interventions and also identify scenarios were those interventions are of little value to the DLS patient. In addition, the panel and symposium participants will openly discuss the value of the traditional stepwise care approach for DLS.
Upon completion of this session, participants should gain strategies to:
- Develop a patient-centered, outcomes-based approach to the management of DLS across the continuum of care;
- Consider the relative value of different management options for DLS;
- Identify the right care for the right patient at the right time.
Agenda
- Introduction and Case Presentation
Raja Y. Rampersaud, MD, FRCSC
- Self-Management and Allied Health Interventions
Gregory L. Whitcomb, DC
- Pain Management: Pills to Interventional Procedures
Aneesh K. Singla, MD
- Surgery: The Role for Decompression Alone
Raja Y. Rampersaud, MD, FRCSC
- Surgery: The Role for Decompression and Fusion
Zoher Ghogawala, MD
- The Clinical Practice Guideline Perspective: What Role Do They Play Across Disciplines?
Daniel K. Resnick, MD, MS
- The Value Perspective: What is the Cost of Ineffective Care?
Sigurd H. Berven, MD
- Moderated Open Panel and Participant Discussion: Is the Stepwise Approach Justifiable or Do We Need to Better Stratify the Management of DLS?
Faculty Panel