Economics of image guidance and navigation in spine surgery

Abstract

Background:Image-guidance and navigation in spinal surgery is becoming more widely utilized. Several studies have shown the use of this technology to increase accuracy of pedicle screw placement, decrease the rates of revision surgery, and minimize radiation exposure. In this paper, the authors analyze the economics of image-guided surgery (IGS) and navigation in spine surgery.Methods:A literature review was performed using PubMed, the CEA Registry, and the National Health Service Economic Evaluation Database. Each article was screened for inclusion and exclusion criteria, including costs, reoperation, readmission rates, operating room time, and length of stay.Results:Thirteen studies were included in the analysis. Six studies were identified to meet the inclusion criteria for reporting costs and seven met the criteria for analysis of efficacy. Average costs ranged from $17,650 to $39,643. Pedicle screw misplacement rates using IGS ranged from 1.20% to 15.07% while reoperation rates ranged from 0% to 7.42%.Conclusion:There is currently an insufficient amount of studies reporting on the economics of spinal navigation to accurately conclude on its cost-effectiveness in clinical practice. Although a few of these studies showed less costs associated with intraoperative imaging, none were able to establish a statistically significant difference. Preliminary findings drawn from this study indicate a possible cost-effectiveness advantage with IGS, but more comprehensive data on costs need to be reported in order to validate its utilization.

Use of Computer Assistance in Lumbar Fusion Surgery: Analysis of 15 222 Patients in the ACS-NSQIP Database

“…Nevertheless, a recent review by Al-Khouja et al concluded that there is no sufficient data in the literature on the cost-effectiveness of CAS; however, their results lean toward cost-effectiveness of CAS. 19 In the present study, the rate of blood transfusion was significantly lower in the CAS group (11.0%) when compared with the conventional techniques (17.3%). For just one of the many complications seen postoperatively to be greater in the conventional group versus CAS, the cost-effectiveness for decreased need for blood transfusion alone would demonstrated the effect of CAS on surgical cost-effectiveness.…”

Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

“…The newest generation of navigation technology—intraoperative computed tomography image-guided navigation (CT-IGN) with the mobile O-arm scanner—has made a tremendous impact on spinal surgery and there is a wealth of literature on the topic [ 10 , 11 , 25 ]. Increasing imaging resolution has led to improved accuracy of instrumentation placement in the thoracic and lumbar spine, primary versus revision cases, which has in turn led to overall superior clinical outcomes [ 6 – 9 , 12 ].…”

“…Current capital expenditure costs for the O-arm mobile CT scanner are estimated to be approximately $700,000 and the StealthStation guidance system approximately $250,000. Although costs of new technology are steadily decreasing over time, it is imperative that more research on cost-effectiveness be undertaken in order to financially justify navigation technology [ 10 ].…”

Facet Fixation Combined with Lumbar Interbody Fusion: Comparative Analysis of Clinical Experience and A New Method of Surgical Treatment of Patients with Lumbar Degenerative Diseases

“…Тем не менее даже применение вышеперечис-ленных способов не позволяет во всех случаях избежать рисков повреждения содержимого позвоночного канала [30]. Кроме того, современное оборудование требует зна-чительных экономических затрат -на приобретение, содержание, обучение медицинского персонала работе с ним [31]. В отличие от транспедикулярной фиксации фасеточная фиксация кейджем не несет значительных рисков повреждения интраканальных структур, так как осуществляется вне проекции от позвоночного канала структуры.…”