| Is intraoperative CT of posterior cervical spine instrumentation cost-effective and does it reduce complications? | |
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MedLine Citation:
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PMID: 20922584 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Symptomatic multilevel cervical myelopathy is often addressed using posterior decompression using two-dimensional fluoroscopy. Intraoperative three-dimensional fluoroscopy provides more accurate information on the position of instrumentation to prevent screw-related complications. QUESTIONS/PURPOSES: We documented the incidence of hardware-related complications and evaluate cost-effectiveness when using intraoperative three-dimensional fluoroscopy (ISO-C CT) in posterior cervical spine surgery. METHODS: Records from 87 patients who underwent posterior cervical decompression and instrumented fusion for multilevel cervical spondylosis with myelopathy were retrospectively reviewed. Patients in whom a lateral mass, pars, or pedicle screw was removed or revised based on intraoperative ISO-C CT was recorded. Cost analysis was performed using 2008 Medicare reimbursements and was compared against cost estimates for ISO-C CT. RESULTS: Seven patients (8%) had screws changed based on the results of the three-dimensional fluoroscopy: 0.5% of lateral mass screws, 3.1% of thoracic pedicle screws, and 15% of C2 pars screws. No patients who had evaluation of hardware with the ISO-C CT required a return to surgery for complications secondary to hardware failure, malposition, or cutout. CONCLUSIONS: Cost savings are achieved if use of intraoperative ISO-C CT prevents eight patients from requiring a return to the operating room. If every malpositioned screw has the potential to be symptomatic, then 240 patients must have screws placed to be cost-effective. ISO-C CT can safely replace postoperative CT as the standard of care in patients undergoing posterior cervical spinal fusion. LEVEL OF EVIDENCE: Level III, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence. |
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Authors:
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Andrew C Hecht; Steven M Koehler; Janelle C Laudone; Arthur Jenkins; Sheeraz Qureshi |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Clinical orthopaedics and related research Volume: 469 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-03-04 Completed Date: 2011-05-12 Revised Date: 2012-04-02 |
Medline Journal Info:
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Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States |
Other Details:
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Languages: eng Pagination: 1035-41 Citation Subset: AIM; IM |
Affiliation:
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Leni and Peter W May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA. andrew.hecht@mountsinai.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Bone Screws Cervical Vertebrae / radiography, surgery* Child Cost-Benefit Analysis Decompression, Surgical* / adverse effects, economics Female Hospital Costs Humans Imaging, Three-Dimensional Incidence Insurance, Health, Reimbursement Intraoperative Care / economics Male Medicare / economics Middle Aged Postoperative Complications / economics, etiology, prevention & control* Radiographic Image Interpretation, Computer-Assisted Retrospective Studies Spinal Cord Diseases / economics, radiography, surgery* Spinal Fusion* / adverse effects, economics, instrumentation Spondylosis / economics, radiography, surgery* Tomography, X-Ray Computed* / economics Treatment Outcome United States Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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