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Author's reply
David Choi
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
Mr Todd correctly states that the efficacy of interspinous distractors is similar to that of conventional decompressive surgery. However, although the cost of the ID device is more than not using an ID device, there are no cost-effectiveness studies in the UK that determine whether the total cost of surgery is more with an ID device (given that the duration of theatre time is less, these devices can be inserted under local anaesthesia, and in-patient stay is shorter). Whereas the ID device cost may be greater, the statement that “the ID operation is more expensive” is not substantiated.
ID devices are now less commonly used because many surgeons realise that they are not a replacement for conventional decompressive surgery, and clinical improvements may be short-lived. This has been corroborated by the randomised trials mentioned. ID devices may, however, still have indications in selected patients who are unsuitable for prolonged general anaesthesia. We agree that ID devices are certainly not a “miracle cure”.