Achieving Value in Spine Surgery: 10 Major Cost Contributors

Area of Science:

• Spine Surgery
• Healthcare Economics
• Value-Based Care

Background:

• Rising healthcare costs and spine disease burden necessitate value-based care in spine surgery.
• Current practices often show overuse of resources without clear clinical benefit, despite national recommendations.
• A shift towards evidence-based, cost-effective treatments is crucial for sustainable spine care.

Purpose of the Study:

• To identify and discuss 10 specific areas in spine surgery characterized by high costs and minimal demonstrated benefits.
• To highlight opportunities for research and quality improvement initiatives to enhance the value of spine care.
• To inform clinicians and policymakers about areas of potential overuse and under-benefit in current spine surgery practices.

Main Methods:

• A narrative review of existing literature was conducted.
• Ten key areas in spine surgery were identified through a service-wide poll, focusing on high cost and low benefit.
• The review synthesizes cost and clinical data for each identified area.

Main Results:

• Over-referral, over-imaging, and overdiagnosis are prevalent issues.
• Advanced imaging use for low back pain, C-spine clearance, and spinal trauma is often disproportionate to benefit.
• Neuromonitoring, bracing, biologics, robotic assistance, and unnecessary perioperative testing represent other areas of concern.

Conclusions:

• Defining quality and acceptable costs per unit of quality is essential for value-based spine surgery.
• Ten specific areas are highlighted as overpriced and underbeneficial, requiring targeted research and quality improvement.
• Implementing evidence-based practices in these areas can lead to significant improvements in the value of spine care.