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Image-guided pedicle screws using intraoperative cone-beam CT and navigation. A cost-effectiveness study
1Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom.
Summary
Image-guided surgery with intraoperative navigation significantly reduces revision surgeries for pedicle screw malposition. This technology is cost-effective, making its high acquisition cost justifiable for improving patient outcomes.
Area of Science:
- Spine Surgery
- Medical Technology
- Health Economics
Background:
- Image-guided surgery using intraoperative cone-beam CT and navigation enhances pedicle screw accuracy.
- High acquisition costs are a barrier to adopting this advanced surgical technology.
Purpose of the Study:
- To evaluate the cost-effectiveness of intraoperative navigation by comparing revision surgery costs for pedicle screw malposition.
- To determine if the benefits of intraoperative navigation justify its initial investment.
Main Methods:
- Retrospective cost-effectiveness analysis comparing navigated vs. freehand pedicle screw instrumentation over 4 years.
- Calculation of revision surgery costs including length of stay, ICU, theatre time, implants, and outpatient appointments.
Main Results:
- 19 patients required revision surgery for symptomatic pedicle screw malposition; none had screws placed with navigation.
- Revision surgery resulted in an additional 304 bed days and 97 theatre hours, costing £464,038 over 4 years.
- Acquiring and maintaining navigation technology was found to be cost-neutral when compared to revision costs.
Conclusions:
- Intraoperative image-guided surgery reduces reoperation rates for symptomatic pedicle screw malposition.
- This technology is cost-effective in high-volume centers, justifying its high acquisition and maintenance costs through improved patient outcomes.
