Department of Neurosurgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Neurosurg Focus. 2012 Jul;33(1):E12. doi: 10.3171/2012.2.FOCUS121.
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.
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.
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).
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.
辅助技术在确认椎弓根螺钉置钉中的应用存在较大差异。虽然有文献支持使用神经生理监测和等中心透视来确认椎弓根螺钉定位，但没有研究探讨这些技术的成本效益。本研究比较了多节段脊柱融合术后退行性腰椎疾病中使用等中心 O 臂透视、神经生理监测和术后 CT 扫描来确认椎弓根螺钉位置的成本效益和效果。
从 4 位使用 3 种不同策略监测多节段腰椎退行性疾病椎弓根螺钉置钉的脊柱外科医生处收集回顾性数据。建立决策分析模型，分析 3 种不同监测策略的成本和结果。共纳入 2005 年至 2010 年间进行的 448 例手术，其中 4 例因螺钉位置不当而需要再次手术。选择其中 64 例患者进行结构访谈，使用 EuroQol-5D 问卷。根据再次手术的发生率及其对生活质量和成本的负面影响，计算预期成本和质量调整生命年。
决策分析模型表明，O 臂监测策略的成本明显低于术中单平面透视后行术后 CT 扫描的策略（p<0.001），而后者的成本又明显低于神经生理监测（p<0.001）。不同监测策略的效果差异不显著（p=0.92）。
与分析的 3 种技术中的其他两种技术相比，使用 O 臂来确认椎弓根螺钉置钉的位置是最具成本效益的策略。
