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

2012 ◽  
Vol 33 (1) ◽  
pp. E12 ◽  
Author(s):  
Matthew R. Sanborn ◽  
Jayesh P. Thawani ◽  
Robert G. Whitmore ◽  
Michael Shmulevich ◽  
Benjamin Hardy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pedicle Screw ◽  
Ct Scanning ◽  
Screw Placement ◽  
Neurophysiological Monitoring ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Pedicle Screw Placement ◽  
Monitoring Strategies ◽  
Repeat Operation

Object 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. Methods 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. Results The decision analysis model demonstrated that the O-arm monitoring strategy is significantly (p < 0.001) less costly than the strategy of postoperative CT scanning following intraoperative uniplanar fluoroscopy, which in turn is significantly (p < 0.001) less costly than neurophysiological monitoring. The differences in effectiveness of the different monitoring strategies are not significant (p = 0.92). Conclusions 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.

Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement

2002 ◽  
Vol 97 (2) ◽  
pp. 223-226 ◽  
Author(s):  
Ganesh Rao ◽  
Darrel S. Brodke ◽  
Matthew Rondina ◽  
Andrew T. Dailey
Keyword(s):  
Pedicle Screw ◽  
Computerized Tomography ◽  
Predictive Value ◽  
Ct Scanning ◽  
Screw Placement ◽  
Direct Visualization ◽  
Pedicle Screw Placement ◽  
Content Type ◽  
Thoracic Pedicle Screw ◽  
Fine Print

Object. To validate computerized tomography (CT) scanning as a tool to assess the accuracy of thoracic pedicle screw placement, the authors compared its accuracy with that of direct visualization in instrumented cadaveric spine specimens. Methods. A grading scale was devised to score the placement of the pedicle screw. The grades ranged from 0 to 3 depending on the extent to which the pedicle had been violated. One hundred fifty-five pedicles were fitted with instrumentation in eight cadaveric spines. A single observer graded the appearance of the screw based on CT scans (3-mm axial sections with 1-mm overlap) and direct visualization of the specimen. The authors arrived at a Kappa value of 0.51, which suggested only moderate agreement between the two measurement techniques. Whereas CT had a positive predictive value of 95%, it had a negative predictive value of 62%. Conclusions. The authors thus conclude that although CT scanning is the most valid tool to assess the accuracy of thoracic pedicle screw placement, it tends to overestimate the number of misplaced screws.

Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws

2014 ◽  
Vol 21 (3) ◽  
pp. 320-328 ◽  
Author(s):  
Mohamad Bydon ◽  
Risheng Xu ◽  
Anubhav G. Amin ◽  
Mohamed Macki ◽  
Paul Kaloostian ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Ct Scanning ◽  
Screw Placement ◽  
Cervical Region ◽  
Consecutive Series ◽  
Pedicle Screw Placement ◽  
Intraoperative Ct

Object A number of imaging techniques have been introduced to minimize the risk of pedicle screw placement. Intraoperative CT has been recently introduced to assist in spinal instrumentation. The aim of this study was to study the effectiveness of intraoperative CT in enhancing the safety and accuracy of pedicle screw placement. Methods The authors included all cases from December 2009 through July 2012 in which intraoperative CT scanning was used to confirm pedicle screw placement. Results A total of 203 patients met the inclusion criteria. Of 1148 screws, 103 screws (8.97%) were revised intraoperatively in 72 patients (35.5%): 14 (18.42%) were revised in the cervical spine (C-2 or C-7), 25 (7.25%) in the thoracic spine, and 64 (8.80%) in the lumbar spine. Compared with screws in the thoracic and lumbar regions, pedicle screws placed in the cervical region were statistically more likely to be revised (p = 0.0061). Two patients (0.99%) required reoperations due to undetected misplacement of pedicle screws. Conclusions The authors describe one of the first North American experiences using intraoperative CT scanning to confirm the placement of pedicle screws. Compared with a similar cohort of patients from their institution who had pedicle screws inserted via the free-hand technique with postoperative CT, the authors found that the intraoperative CT lowers the threshold for pedicle screw revision, resulting in a statistically higher rate of screw revision in the thoracic and lumbar spine (p < 0.0001). During their 2.5-year experience with the intraoperative CT, the authors did not find a reduction in rates of reoperation for misplaced pedicle screws.

Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine

2021 ◽  
Author(s):  
Yann Philippe Charles ◽  
Yves Ntilikina ◽  
Arnaud Collinet ◽  
Sébastien Schuller ◽  
Julien Garnon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

scholarly journals Overview of Robotic Technology in Spine Surgery

2021 ◽  
pp. 155633162110266
Author(s):  
Ram K. Alluri ◽  
Fedan Avrumova ◽  
Ahilan Sivaganesan ◽  
Avani S. Vaishnav ◽  
Darren R. Lebl ◽  
...  
Keyword(s):  
Economic Impact ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Screw Placement ◽  
Complication Rates ◽  
Robotic Technology ◽  
Pedicle Screw Placement ◽  
The Past ◽  
Compare And Contrast

As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.

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