Wiedenhöfer Bernd, Nacke Joachim, Stephan Mike, Richter Wiltrud, Carstens Claus, Eichler Markus
*Department of Orthopaedics, Trauma Surgery and Spinal Cord Injury †Department of Anaesthesiology ‡Research Centre for Experimental Orthopaedics University Hospital of Heidelberg, Heidelberg §Stadtklinik Baden-Baden, Baden-Baden, Germany.
Clin Spine Surg. 2017 Jun;30(5):E530-E534. doi: 10.1097/BSD.0000000000000189.
A retrospective study.
The objective of this study was to assess the cost-effectiveness and clinical outcome of motion-preserving versus fusion procedures in cervical spine surgery.
During the last decade there has been a huge growth in spine surgery with a concurrent increase in the economic burden. Currently, there appear to be no differences in clinical outcome between cervical total disk replacement (TDR) and spinal fusion (SF). For this reason it seems useful to know within the decision-making process whether there is a difference in actual cost between motion-preserving and fusion surgery. So far data that describe expenses involved in these procedures have not been available. This study offers a comparison of economic factors that should be considered in TDR and SF.
The German statutory general healthcare insurance (GHI) provides anonymized patient-related data of their customers. A retrospective query using the codes of surgery of all TDR and SF surgery was performed from January 2003 to June 2008. A total of 467 cases with monosegmental or bisegmental surgery for degenerative disk pathologies were included.
Both groups showed significant differences in independent variables such as age and sex (P<0.0001), but not in revision rates. Cost weight of diagnosis-related groups and length of hospitalization had a significant effect on total costs. Both groups obtained less pain medication postoperatively than preoperatively without a significant difference between each group. Postoperative absenteeism from work was significantly higher in the TDR group;however, patients with TDR underwent less rehabilitation covered by the GHI. Both groups had the same amount of preoperative and postoperative physiotherapy covered by the GHI.
According to the collected data, there are no differences between the medical outcomes of cervical TDR in comparison with cervical SF. At the same time, while generating clinical results comparable with spinal fusion, TDR incurred significantly lower costs. Therefore, both from the medical and from the financial point of view, TDR is a viable choice in the treatment of degenerative disk pathology.
一项回顾性研究。
本研究的目的是评估颈椎手术中保留运动功能手术与融合手术的成本效益和临床结果。
在过去十年中，脊柱手术有了巨大增长，同时经济负担也在增加。目前，颈椎全椎间盘置换术（TDR）和脊柱融合术（SF）在临床结果上似乎没有差异。因此，在决策过程中了解保留运动功能手术和融合手术在实际成本上是否存在差异似乎很有用。到目前为止，尚无描述这些手术所涉及费用的数据。本研究对TDR和SF中应考虑的经济因素进行了比较。
德国法定的一般医疗保险（GHI）提供其客户的匿名患者相关数据。对2003年1月至2008年6月期间所有TDR和SF手术的手术编码进行回顾性查询。共纳入467例因退行性椎间盘病变接受单节段或双节段手术治疗的病例。
两组在年龄和性别等自变量上存在显著差异（P<0.0001），但在翻修率上无差异。诊断相关组的成本权重和住院时间对总成本有显著影响。两组术后使用的止痛药均比术前减少，且两组之间无显著差异。TDR组术后旷工率显著更高；然而，接受TDR治疗的患者接受GHI覆盖的康复治疗较少。两组术前和术后接受GHI覆盖的物理治疗量相同。
根据收集的数据，颈椎TDR与颈椎SF的医疗结果无差异。同时，在产生与脊柱融合相当的临床结果的同时，TDR的成本显著更低。因此，从医学和财务角度来看，TDR都是治疗退行性椎间盘病变的可行选择。
