4 research outputs found
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An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion Presented at the 2009 Joint Spine Section Meeting Clinical article
Object. Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures produce their intended result and even fewer objective data to demonstrate that they are cost effective when compared with open surgery.
Methods. The authors performed a retrospective analysis of hospital charges for 1- and 2-level MIS and open posterior interbody fusion for lumbar spondylotic disease, disc degeneration, and spondylolisthesis treated at a single academic medical center. Patients presenting with bilateral neurological symptoms were treated with open surgery, and those with unilateral symptoms were treated with MIS. Overall hospital charges and surgical episode related charges, length of stay (LOS), and discharge status were obtained from the hospital finance department and adjusted for multi-/single-level surgeries.
Results. During a 14-month period, 74 patients (mean age 55 years) were treated. The series included 59 single-level operations (75% MIS and 25% open), and 15 2-level surgeries (53% MIS and 47% open). The demographic profile, including age and Charlson Comorbidity Index, were similar between the 4 groups. The mean LOS for patients undergoing single-level surgery was 3.9 and 4.8 days in the MIS and open cases, respectively (p = 0.017). For those undergoing 2-level surgery, the mean LOS was 5.1 for MIS versus 7.1 for open surgery (p = 0.259). With respect to hospital charges, single-level MIS procedures were associated with an average of 78,444 for open surgery (p = 0.027). For 2-level surgery, mean charges totalled 108,843 for open surgery (p = 0.071). For single-level surgeries, 5 and 20% of patients undergoing MIS and open surgery, respectively, were discharged to inpatient rehabilitation. For 2-level surgeries, the rates were 13 and 29%, respectively.
Conclusions. While hospital setting, treatment population, patient selection, and physician expectation play major roles in determining hospital charges and LOS, this pilot study at an academic teaching hospital shows trends for quicker discharge, reduced hospital charges, and lower transfer rates to inpatient rehabilitation with MIS. However, larger multicenter studies are necessary to validate these findings and their relevance across diverse US practice environments. (DOI: 10.3171/2009.12.SPINE09621
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An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion: Clinical article
An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion
Real-time navigation guidance with intraoperative CT imaging for pedicle screw placement using an augmented reality head-mounted display: a proof-of-concept study.
OBJECTIVE: Augmented reality (AR) has the potential to improve the accuracy and efficiency of instrumentation placement in spinal fusion surgery, increasing patient safety and outcomes, optimizing ergonomics in the surgical suite, and ultimately lowering procedural costs. The authors sought to describe the use of a commercial prototype Spine AR platform (SpineAR) that provides a commercial AR head-mounted display (ARHMD) user interface for navigation-guided spine surgery incorporating real-time navigation images from intraoperative imaging with a 3D-reconstructed model in the surgeon\u27s field of view, and to assess screw placement accuracy via this method.
METHODS: Pedicle screw placement accuracy was assessed and compared with literature-reported data of the freehand (FH) technique. Accuracy with SpineAR was also compared between participants of varying spine surgical experience. Eleven operators without prior experience with AR-assisted pedicle screw placement took part in the study: 5 attending neurosurgeons and 6 trainees (1 neurosurgical fellow, 1 senior orthopedic resident, 3 neurosurgical residents, and 1 medical student). Commercially available 3D-printed lumbar spine models were utilized as surrogates of human anatomy. Among the operators, a total of 192 screws were instrumented bilaterally from L2-5 using SpineAR in 24 lumbar spine models. All but one trainee also inserted 8 screws using the FH method. In addition to accuracy scoring using the Gertzbein-Robbins grading scale, axial trajectory was assessed, and user feedback on experience with SpineAR was collected.
RESULTS: Based on the Gertzbein-Robbins grading scale, the overall screw placement accuracy using SpineAR among all users was 98.4% (192 screws). Accuracy for attendings and trainees was 99.1% (112 screws) and 97.5% (80 screws), respectively. Accuracy rates were higher compared with literature-reported lumbar screw placement accuracy using FH for attendings (99.1% vs 94.32%; p = 0.0212) and all users (98.4% vs 94.32%; p = 0.0099). The percentage of total inserted screws with a minimum of 5° medial angulation was 100%. No differences were observed between attendings and trainees or between the two methods. User feedback on SpineAR was generally positive.
CONCLUSIONS: Screw placement was feasible and accurate using SpineAR, an ARHMD platform with real-time navigation guidance that provided a favorable surgeon-user experience