Cost-effectiveness of confirmatory techniques for the placement of lumbar pedicle screws

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>There is considerable variation in the use of adjunctive technologies to confirm pedicle screw placement. Although there is literature to support the use of both neurophysiological monitoring and isocentric fluoroscopy to confirm pedicle screw positioning, there are no studies examining the cost-effectiveness of these technologies. This study compares the cost-effectiveness and efficacy of isocentric O-arm fluoroscopy, neurophysiological monitoring, and postoperative CT scanning after multilevel instrumented fusion for degenerative lumbar disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective data were collected from 4 spine surgeons who used 3 different strategies for monitoring of pedicle screw placement in multilevel lumbar degenerative disease. A decision analysis model was developed to analyze costs and outcomes of the 3 different monitoring strategies. A total of 448 surgeries performed between 2005 and 2010 were included, with 4 cases requiring repeat operation for malpositioned screws. A sample of 64 of these patients was chosen for structured interviews in which the EuroQol-5D questionnaire was used. Expected costs and quality-adjusted life years were calculated based on the incidence of repeat operation and its negative effect on quality of life and costs.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The decision analysis model demonstrated that the O-arm monitoring strategy is significantly (p &lt; 0.001) less costly than the strategy of postoperative CT scanning following intraoperative uniplanar fluoroscopy, which in turn is significantly (p &lt; 0.001) less costly than neurophysiological monitoring. The differences in effectiveness of the different monitoring strategies are not significant (p = 0.92).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Use of the O-arm for confirming pedicle screw placement is the least costly and therefore most cost-effective strategy of the 3 techniques analyzed.</jats:p></jats:sec>

Accuracy of Pedicle Screw Placement in Scoliosis Surgery: A Comparison between Conventional Computed Tomography-Based and O-Arm-Based Navigation Techniques

“…For the operative staff, the exposure is nearly zero because the whole surgical team leaves the operation room during the CT scan. Regarding the cost, Sanborn et al [27] reported that using the O-arm for confirming pedicle screw placement was the most cost-effective strategy compared to neurophysiological monitoring and isocentric fluoroscopy.…”

The accuracy of pedicle screw placement using intraoperative image guidance systems

“…35 However, a recent study by Sanborn et al 43 directly compared the cost effectiveness of O-arm intraoperative neuromonitoring and postoperative CT imaging for the pedicle screw accuracy assessment in patients undergoing at least 3-level lumbar fusions. The calculations were based on 2011 Medicare reimbursement rates, and because the surgical and hospital charges were constant, they were not included in the calculations.…”

“…The authors concluded that the least costly alternative was also the most effective. 43 Furthermore, if according to Hodges et al, an estimated 1% of patients would require pedicle screw revision, the nationwide annual cost was approximated to reach $40,595,000, not considering the costs associated with morbidity.…”

Role of Cranial and Spinal Virtual and Augmented Reality Simulation Using Immersive Touch Modules in Neurosurgical Training

“…Currently, the two most frequently used methods to place pedicle screws are (i) via visualization by the surgeon and (ii) via intraoperative CT-guided screw placement 20, 21 . For the former, intraoperative X-Ray confirms screw placement, whereas the latter technique allows for real-time visualization of screw placement without the need for X-Ray imaging.…”