Hart Robert A, Prendergast Michael A, Roberts Warren G, Nesbit Gary M, Barnwell Stanley L
Department of Orthopaedics and Rehabilitation and Dotter Interventional Institute, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, OP31, Portland, OR 97239-3098, USA.
Spine J. 2008 Nov-Dec;8(6):875-81. doi: 10.1016/j.spinee.2008.01.015. Epub 2008 Apr 2.
Limited data are available regarding incidence of proximal junctional acute collapse after multilevel lumbar spine fusion. There are no data regarding the cost of prophylactic vertebral augmentation adjacent to long lumbar fusions compared with the costs of performing revision fusion surgery for patients suffering with this complication.
To perform a cost analysis of prophylactic vertebral augmentation for prevention of proximal junctional acute collapse after multilevel lumbar fusion.
Retrospective chart review and cost analysis.
All female patients older than 60 years undergoing extended lumbar fusions were reviewed to establish the incidence of proximal junctional acute collapse.
Cost estimates for two-level vertebroplasty, two-level kyphoplasty, and revision instrumented fusion were calculated using billing data and cost-to-charge ratios.
Cost comparisons of prophylactic vertebral augmentation versus extension of fusion for patients suffering from proximal junctional acute collapse were performed.
Twenty-eight female patients older than 60 years underwent lumbar fusions from L5 or S1 extending to the thoracolumbar junction (T9-L2). Fifteen of the 28 patients had prophylactic vertebroplasty cranial to the fused segment. Proximal junctional acute collapse requiring revision surgery occurred in 2 of the 13 patients (15.3%) treated without prophylactic vertebroplasty. None of the 15 patients undergoing cement augmentation experienced this complication. Assuming a 15% decrease in the incidence of proximal junctional acute collapse, the estimated cost to prevent a single proximal junctional acute collapse was $46,240 using vertebroplasty and $82,172 using kyphoplasty. Inpatient costs associated with a revision instrumented fusion averaged $77,432.
Prophylactic vertebral augmentation for the prevention of proximal junctional acute collapse may be a cost effective intervention in elderly female patients undergoing extended lumbar fusions. Further efforts are needed to determine more precisely the incidence of proximal junctional acute collapse and the effects of various risk factors on increasing this incidence, as well as methods of prevention.
关于多节段腰椎融合术后近端交界区急性塌陷的发生率，可用数据有限。与为发生该并发症的患者进行翻修融合手术的费用相比，尚无关于长节段腰椎融合术相邻节段预防性椎体强化费用的数据。
对预防性椎体强化预防多节段腰椎融合术后近端交界区急性塌陷进行成本分析。
回顾性病历审查和成本分析。
对所有60岁以上接受长节段腰椎融合术的女性患者进行审查，以确定近端交界区急性塌陷的发生率。
使用计费数据和成本收费比计算二级椎体成形术、二级后凸成形术和翻修器械融合术的成本估计值。
对预防性椎体强化与近端交界区急性塌陷患者融合节段延长的成本进行比较。
28例60岁以上女性患者接受了从L5或S1至胸腰段交界区（T9-L2）的腰椎融合术。28例患者中有15例在融合节段上方进行了预防性椎体成形术。在未进行预防性椎体成形术治疗的13例患者中，有2例（15.3%）发生了需要翻修手术的近端交界区急性塌陷。接受骨水泥强化的15例患者均未发生该并发症。假设近端交界区急性塌陷的发生率降低15%，使用椎体成形术预防单次近端交界区急性塌陷估计成本为46,240美元，使用后凸成形术为82,172美元。翻修器械融合术的住院费用平均为77,432美元。
对于接受长节段腰椎融合术的老年女性患者，预防性椎体强化预防近端交界区急性塌陷可能是一种具有成本效益的干预措施。需要进一步努力更精确地确定近端交界区急性塌陷的发生率以及各种风险因素对增加该发生率的影响，以及预防方法。
