Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis

Dea, Nicolas; Fisher, Charles G.; Batke, Juliet; Strelzow, Jason; Mendelsohn, Daniel; Paquette, Scott; Kwon, Brian K.; Boyd, Michael; Dvorak, Marcel F.; Street, John

doi:10.1016/j.spinee.2015.09.062

Cited by 102 publications

(65 citation statements)

References 42 publications

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“…Intraoperative imaging of screw position is imperative to identify and move incorrectly placed screws without costly revision surgery . The diagnostic imaging performance of both units remains less than that of conventional CT .…”

Section: Discussionmentioning

confidence: 99%

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Nachabé

Strauss

Schueler

et al. 2019

J Applied Clin Med Phys

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Careful protocol selection is required during intraoperative three‐dimensional (3D) imaging for spine surgery to manage patient radiation dose and achieve clinical image quality. Radiation dose and image quality of a Medtronic O‐arm commonly used during spine surgery, and a Philips hybrid operating room equipped with XperCT C‐arm 3D cone‐beam CT (hCBCT) are compared. The mobile O‐arm (mCBCT) offers three different radiation dose settings (low, standard, and high), for four different patient sizes (small, medium, large, and extra large). The patient's radiation dose rate is constant during the entire 3D scan. In contrast, C‐CBCT spine imaging uses three different field of views (27, 37, and 48 cm) using automatic exposure control (AEC) that modulates the patient's radiation dose rate during the 3D scan based on changing patient thickness. hCBCT uses additional x‐ray beam filtration. Small, medium, and large trunk phantoms designed to mimic spine and soft tissue were imaged to assess radiation dose and image quality of the two systems. The estimated measured “patient” dose for the small, medium, and large phantoms imaged by the mCBCT considering all the dose settings ranged from 9.4–27.6 mGy, 8.9–33.3 mGy, and 13.8–40.6 mGy, respectively. The “patient” dose values for the same phantoms imaged with hCBCT were 2.8–4.6 mGy, 5.7–10.0 mGy, and 11.0–15.2 mGy. The CNR for the small, medium, and large phantoms was 2.9 to 3.7, 2.0 to 3.0, and 2.5 to 2.6 times higher with the hCBCT system, respectively. Hounsfield unit accuracy, noise, and uniformity of hCBCT exceeded the performance of the mCBCT; spatial resolution was comparable. Added x‐ray beam filtration and AEC capability achieved clinical image quality for intraoperative spine surgery at reduced radiation dose to the patient in comparison to a reference O‐arm system without these capabilities.

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Section: Discussionmentioning

confidence: 99%

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Nachabé

Strauss

Schueler

et al. 2019

J Applied Clin Med Phys

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show abstract

“…In particular, the costs are much less, both to purchase and maintain with respect to traditional navigation systems, such as intraoperative CT scan or intraoperative magnetic resonance imaging. [18][19][20][21][22][23] Radermacher et al 24 first described, in 1998, a patient-specific template used as an in situ drill guide, designed with a preoperative CT scan. This tool was then further developed, which improved accuracy rates of pedicle screw insertion.…”

Section: Discussionmentioning

confidence: 99%

Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

et al. 2019

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“…Currently, the primary measurement of efficiency is the number of reoperations for a misplaced screw done within one year, and the secondary measure includes the adverse event rate, surgical time, and length of stay. Dr. Charles Fisher reported on his study (15) which analyzed cost-effectiveness of intraoperative CT based navigation systems. The authors concluded that this technology is economically justified, predominantly due to the reduction of reoperation rates due to higher screw placement accuracy (15).…”

Section: This Brings Up the Question: Is Investing In Spinal Navigatimentioning

confidence: 99%

“…Dr. Charles Fisher reported on his study (15) which analyzed cost-effectiveness of intraoperative CT based navigation systems. The authors concluded that this technology is economically justified, predominantly due to the reduction of reoperation rates due to higher screw placement accuracy (15). They calculated a costeffectiveness ratio of $15,962 USD ($12,618 CAD) per reoperation that was prevented in patients undergoing fusion procedures.…”

Section: This Brings Up the Question: Is Investing In Spinal Navigatimentioning

confidence: 99%

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

Drazin¹,

Grunert²,

Härtl³

et al. 2018

Ann. Transl. Med.

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Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis

Cited by 102 publications

References 42 publications

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Radiation dose and image quality comparison during spine surgery with two different, intraoperative 3D imaging navigation systems

Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

Highlights from the First Annual Spinal Navigation, Emerging Technologies and Systems Integration Meeting

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