• Andrew C Hecht, Steven M Koehler, Janelle C Laudone, Arthur Jenkins, and Sheeraz Qureshi.
• Leni and Peter W May Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 East 98th Street, 9th Floor, New York, NY 10029, USA. andrew.hecht@mountsinai.org
• Clin. Orthop. Relat. Res. 2011 Apr 1;469(4):1035-41.

BackgroundSymptomatic multilevel cervical myelopathy is often addressed using posterior decompression using two-dimensional fluoroscopy. Intraoperative three-dimensional fluoroscopy provides more accurate information on the position of instrumentation to prevent screw-related complications.Questions/PurposesWe documented the incidence of hardware-related complications and evaluate cost-effectiveness when using intraoperative three-dimensional fluoroscopy (ISO-C CT) in posterior cervical spine surgery.MethodsRecords from 87 patients who underwent posterior cervical decompression and instrumented fusion for multilevel cervical spondylosis with myelopathy were retrospectively reviewed. Patients in whom a lateral mass, pars, or pedicle screw was removed or revised based on intraoperative ISO-C CT was recorded. Cost analysis was performed using 2008 Medicare reimbursements and was compared against cost estimates for ISO-C CT.ResultsSeven patients (8%) had screws changed based on the results of the three-dimensional fluoroscopy: 0.5% of lateral mass screws, 3.1% of thoracic pedicle screws, and 15% of C2 pars screws. No patients who had evaluation of hardware with the ISO-C CT required a return to surgery for complications secondary to hardware failure, malposition, or cutout.ConclusionsCost savings are achieved if use of intraoperative ISO-C CT prevents eight patients from requiring a return to the operating room. If every malpositioned screw has the potential to be symptomatic, then 240 patients must have screws placed to be cost-effective. ISO-C CT can safely replace postoperative CT as the standard of care in patients undergoing posterior cervical spinal fusion.Level Of EvidenceLevel III, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

52 keywords...

hide…