Is Intraoperative CT of Posterior Cervical Spine Instrumentation Cost-effective and Does It Reduce Complications?

Hecht, Andrew C.; Koehler, Steven M.; Laudone, Janelle C.; Jenkins, Arthur; Qureshi, Sheeraz
April 2011
Clinical Orthopaedics & Related Research;Apr2011, Vol. 469 Issue 4, p1035
Academic Journal
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.


Related Articles

  • Unilateral laminoplasty with lateral mass screw fixation for less invasive decompression of the cervical spine: a biomechanical investigation. Schmeiser, Gregor; Schilling, C.; Grupp, T.; Papavero, L.; Püschel, K.; Kothe, R.; Grupp, T M; Püschel, K // European Spine Journal;Dec2015, Vol. 24 Issue 12, p2781 

    Purpose: To compare the stabilization behavior of additional unilateral mass screw fixation with current standard procedures in patients with cervical spondylotic myelopathy (CSM) in a biomechanical study.Methods: Ten human C2-C7 cervical specimens were tested under...

  • Quality of life improved with surgical treatment for cervical myelopathy. Dimarcantonio, Tina // Orthopedics Today;Mar2010, Vol. 30 Issue 3, p52 

    The article focuses on a study which analyzed the impact of surgical treatment for cervical myelopathy on the quality of life of patients.

  • Intraoperative ISO-C CT may reduce costs for posterior cervical fusion. Chutkan, Norman B. // Orthopedics Today;Dec2010, Vol. 30 Issue 12, p23 

    The article discusses research study by Andrew C. Hect and colleagues, published in "Clinical Orthopaedics and Related Research," on intraoperative 3-D fluoroscopy as a safe and cost-effective alternative to postoperative computed tomography (CT).

  • ACDF results do not match perception.  // AAOS Now;Dec2010, Vol. 4 Issue 12, p17 

    The article focuses on the investigational device exemption (IDE) studies involving anterior cervical decompression and fusion (ACDF) as the control procedure. The studies show that ACDF has 10% reoperation rate due to pseudarthrosis, adjacent level degeneration, or revision of the index...

  • Delayed Bilateral C5 Palsy following Circumferential Decompression and Fusion in Patient with Cervical Spondylotic Myelopathy. Hyeong-Seok Jeon; Keung-Nyun Kim // Korean Journal of Spine;Sep2015, Vol. 12 Issue 3, p200 

    C5 palsy is a common complication after cervical decompressive surgery, which have 0 to 30% complication rate. A 61-year-old female patient with cervical spondylotic myelopathy showed bilateral C5 palsy following circumferential decompression and fusion. Unexpectedly, bilateral C5 palsy was...

  • Comparison of two novel fluoroscopy-based stereotactic methods for cervical pedicle screw placement and review of the literature. Reinhold, M.; Bach, C.; Audigé, L.; Bale, R.; Attal, R.; Blauth, M.; Magerl, F. // European Spine Journal;Apr2008, Vol. 17 Issue 4, p564 

    This experimental study was designed to compare two different fluoroscopy-based stereotactic surgical techniques for transcutaneous cervical pedicle screw (CPS) placement in the subaxial human cervical spine: (1) a custom-made aiming frame (AF) in combination with conventional fluoroscopy versus...

  • Percutaneous Vertebroplasty of the Cervical Spine. Anselmetti, G. C. // Neuroradiology Journal;Sep2009 Supplement, Vol. 22, p147 

    The article discusses the application of percutaneous vertebroplasty for cervical spine diseases. It indicates that percutaneous vertebroplasty involves the percutaneous injection of acrylic bone cement. It is considered as a minimally invasive procedure which increases the strength and...

  • Clinical significance of intramedullary Gd-DTPA enhancement in cervical myelopathy. Ozawa, H; Sato, T; Hyodo, H; Ishii, Y; Morozumi, N; Koizumi, Y; Matsumoto, F; Kasama, F; Aizawa, T; Itoi, E; Kokubun, S // Spinal Cord;May2010, Vol. 48 Issue 5, p415 

    Study design:Prospective multicenter study.Objective:To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated.Setting:Four hospitals in Japan.Methods:A total of...

  • Anterior endoscopically assisted transcervical reconstruction of the upper cervical spine. Bing Wang; Lü, Guohua; Youwen Deng; Weidong Liu; Jing Li; Ivan Cheng // European Spine Journal;Sep2011, Vol. 20 Issue 9, p1526 

    Anterior decompression and/or reconstruction can be an effective method for the surgical treatment of ventral spinal cord compression in the upper cervical spine. Options for traditional surgical approaches include transoral, transnasal, and extraoral. The risk and complex anatomy with the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics