一项比较使用术中透视与计算机断层扫描引导导航进行单节段微创经椎间孔腰椎椎间融合术的疗效及成本分析
An Outcome and Cost Analysis Comparing Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Intraoperative Fluoroscopy versus Computed Tomography-Guided Navigation.
作者信息
Khanna Ryan, McDevitt Joseph L, Abecassis Zachary A, Smith Zachary A, Koski Tyler R, Fessler Richard G, Dahdaleh Nader S
机构信息
Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
出版信息
World Neurosurg. 2016 Oct;94:255-260. doi: 10.1016/j.wneu.2016.07.014. Epub 2016 Jul 14.
BACKGROUND
Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)-based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF.
METHODS
For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective.
RESULTS
Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups (P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room (P = 0.868).
CONCLUSIONS
Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months.
背景
微创经椎间孔腰椎椎体间融合术（TLIF）自作为治疗腰椎间盘退变的融合技术问世以来，已经历了重大发展。微创TLIF通常在术中使用二维荧光X射线进行。然而，基于术中计算机断层扫描（CT）的导航技术在微创TLIF中越来越受欢迎，因为它有助于更好地显示解剖结构，并减少术者和手术室工作人员所受的术中辐射。这是第一项比较微创TLIF中这两种成像技术的临床疗效和成本的研究。
方法
为了进行比较，将28例接受荧光透视下单节段微创TLIF的患者与28例接受CT导航下单节段微创TLIF的患者，根据种族、性别、年龄、吸烟状况、付款人类型和医疗合并症（Charlson合并症指数）进行匹配。最短随访时间为6个月。从付款人的角度比较两组的临床疗效和医院报销情况。
结果
两组的平均手术时间、麻醉时间和住院时间相似，但荧光透视组的平均估计失血量低于CT导航组（154 mL对262 mL；P = 0.016）。在6个月的随访中，两组的Oswestry功能障碍指数、背部视觉模拟评分和腿部视觉模拟评分均有相似改善（P > 0.05）。成本分析表明，荧光透视组和CT导航组的平均住院费用相似（32,347美元对32,656美元；P = 0.925），手术室费用也相似（P = 0.868）。
结论
荧光透视与CT导航下进行的单节段微创TLIF在6个月时显示出相似的临床疗效和成本。
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